FHU IRIS, Department of Interventional Neuroradiology, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France.
Université Claude Bern-ard Lyon 1, Lyon, France.
Neurosurgery. 2018 Jun 1;82(6):854-863. doi: 10.1093/neuros/nyx309.
Onyx is important embolic material in the endovascular treatment of intracranial dural arteriovenous fistula (DAVF). However, its impact on DAVF occlusion rates, morbidity, mortality, and complication rates is not fully examined.
To improve understanding of safety and effectiveness profiles associated with transarterial endovascular treatment using Onyx for intracranial DAVF.
We analyzed data from our prospective clinical registry and conducted a systematic review of all previous transarterial embolization studies using Onyx published between January 2005 and December 2015 in MEDLINE and EMBASE.
In the prospective study, 41 transarterial procedures were performed in 33 consecutive patients harboring 36 DAVFs. Complete initial exclusion was obtained in 32 of 36 (88.9%) fistulas; 31 fistulas were followed up showing 4 (12.9%) recurrences. Procedure-related morbidity and mortality were 3% and 0%, respectively. The literature review identified 19 studies involving a total of 425 patients with 463 DAVFs. Meta-analysis, including our registry data, showed an initial complete occlusion rate of 82% (95% confidence interval [CI]: 74%, 88%; I2, 70.6%), and recurrence rate at midterm of 2% (95% CI: 0%, 5%; I2, 21.5%). Pooled postoperative neurological deficit, procedure-related morbidity, and mortality rates were 4% (95% CI: 2%, 6%; I2, 0%), 3% (95% CI: 1%, 5%; I2, 0%), and 0%, respectively.
This meta-analysis suggests that transarterial embolization with Onyx is a safe treatment modality for DAVFs. Although Onyx showed a low recurrence rate at midterm, the long-term risk is poorly addressed in our study and should warrant a longer follow-up.
Onyx 是颅内硬脑膜动静脉瘘（DAVF）血管内治疗中的重要栓塞材料。然而，其对 DAVF 闭塞率、发病率、死亡率和并发症发生率的影响尚未得到充分研究。
提高对使用 Onyx 经动脉血管内治疗颅内 DAVF 的安全性和有效性的认识。
我们分析了来自我们前瞻性临床登记处的数据，并对 2005 年 1 月至 2015 年 12 月期间在 MEDLINE 和 EMBASE 上发表的所有使用 Onyx 进行经动脉栓塞治疗的研究进行了系统回顾。
在前瞻性研究中，33 例连续患者的 36 个 DAVF 中进行了 41 次经动脉治疗。36 个瘘管中有 32 个（88.9%）获得了完全初始闭塞；31 个瘘管进行了随访，发现 4 个（12.9%）复发。与治疗相关的发病率和死亡率分别为 3%和 0%。文献综述共纳入 19 项研究，共 425 例患者，共 463 个 DAVF。包括我们的登记数据在内的荟萃分析显示，初始完全闭塞率为 82%（95%置信区间[CI]：74%，88%；I2，70.6%），中期复发率为 2%（95%CI：0%，5%；I2，21.5%）。术后神经功能缺损、与治疗相关的发病率和死亡率的汇总率分别为 4%（95%CI：2%，6%；I2，0%）、3%（95%CI：1%，5%；I2，0%）和 0%。
这项荟萃分析表明，Onyx 经动脉栓塞治疗 DAVF 是一种安全的治疗方法。尽管 Onyx 在中期显示出较低的复发率，但我们的研究未能很好地解决长期风险，应需要更长时间的随访。
