Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, United States.
Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States.
J Clin Neurosci. 2020 Nov;81:295-301. doi: 10.1016/j.jocn.2020.10.007. Epub 2020 Oct 20.
Endovascular embolization of arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs) has become the mainstay in treatment for these pathologies. Traditional techniques required the formation of a proximal plug of Onyx around the microcatheter prior to embolization to avoid reflux. Recently, dual-lumen balloon catheters have been introduced as a potential solution to this issue. We sought to compare our institutional experience with dual-lumen balloons to traditional microcatheters in the endovascular embolization of AVMs and DAVFs. A retrospective analysis of consecutive patients treated with Scepter between 2016 and 2020 was obtained. A control cohort treated with Marathon between 2012 and 2020 was also obtained. Variables collected included patient demographics, procedure times, pedicles treated, operative complications, obliteration rate, and retreatment rate. A total of 44 trial (30 DAVFs and 14 AVMs) and 25 control (15 DAVFs and 10 AVMs) subjects were identified. Average Scepter procedure times were 66.0 and 68.0 min for DAVFs and AVMs, respectively. Average Scepter volume of Onyx injected was 2.2 and 1.4 mL for DAVFs and AVMs, respectively. Complete angiographic occlusion Scepter rate was 86.7% and 50.0% for DAVFs and AVMs, respectively. The Scepter retreatment rate was 13.3% and 50.0% for DAVFs and AVMs, respectively. Predictors of angiographic occlusion included the number of pedicles (OR 0.54, 95%CI 0.30-0.97, p = 0.04). Predictors of retreatment included DAVF (OR 0.16, 95%CI 0.04-0.66, p = 0.01) and Marathon (OR 3.34, 95%CI 1.00-11.56, p = 0.05). Our study shows that dual-lumen balloon catheters are a viable option in the embolization of DAVFs and AVMs.
血管内栓塞治疗动静脉畸形（AVMs）和硬脑膜动静脉瘘（DAVFs）已成为这些病变的主要治疗方法。传统技术需要在栓塞前在微导管周围形成 Onyx 的近端塞子，以避免反流。最近，双腔球囊导管已被引入作为解决这个问题的一种潜在方法。我们试图比较我们机构在 AVM 和 DAVF 的血管内栓塞中使用双腔球囊导管与传统微导管的经验。获得了 2016 年至 2020 年期间使用 Scepter 治疗的连续患者的回顾性分析。还获得了 2012 年至 2020 年期间使用 Marathon 治疗的对照组。收集的变量包括患者人口统计学、手术时间、处理的蒂、手术并发症、闭塞率和再治疗率。共确定了 44 例试验（30 例 DAVFs 和 14 例 AVMs）和 25 例对照（15 例 DAVFs 和 10 例 AVMs）。Scepter 手术时间的平均值分别为 DAVFs 和 AVMs 的 66.0 和 68.0 分钟。Scepter 注射的 Onyx 平均体积分别为 DAVFs 和 AVMs 的 2.2 和 1.4 毫升。DAVFs 和 AVMs 的完全血管造影闭塞 Scepter 率分别为 86.7%和 50.0%。DAVFs 和 AVMs 的 Scepter 再治疗率分别为 13.3%和 50.0%。血管造影闭塞的预测因素包括蒂的数量（OR 0.54，95%CI 0.30-0.97，p=0.04）。再治疗的预测因素包括 DAVF（OR 0.16，95%CI 0.04-0.66，p=0.01）和 Marathon（OR 3.34，95%CI 1.00-11.56，p=0.05）。我们的研究表明，双腔球囊导管是栓塞 DAVFs 和 AVMs 的一种可行选择。
