Omura Yoshihiro, Imamura Hirotoshi, Tani Shoichi, Adachi Hidemitsu, Fukumitsu Ryu, Sunohara Tadashi, Fukui Nobuyuki, Sasaki Natsuhi, Fukuda Tatsumaru, Akiyama Tomoaki, Kajiura Shinji, Shigeyasu Masashi, Asakura Kento, Horii Ryo, Sakai Nobuyuki
Department of Neurosurgery, Kobe City Medical Center General Hospital, Hyogo, Japan.
Department of Neurosurgery, Kobe City Medical Center General Hospital, Hyogo, Japan.
J Stroke Cerebrovasc Dis. 2021 Aug;30(8):105853. doi: 10.1016/j.jstrokecerebrovasdis.2021.105853. Epub 2021 May 23.
Copolymer (Onyx) embolization is an effective treatment for dural arteriovenous fistula (dAVF), however, some dAVFs have multiple, high-flow feeding vessels, resulting in insufficient embolization. For the treatment of such patients, we have developed a novel flow-control technique, the 'damp-and-push technique'. The purpose of this study was to evaluate the technical efficiency and safety of this technique.
Seven patients who had been diagnosed with intracranial dAVF were treated by transarterial Onyx embolization using the damp-and-push technique between 2016 and 2019. This technique was designed to reduce blood flow to the shunt site using a balloon catheter in the major feeding vessel other than the one injected with Onyx, leading to better Onyx penetration and enabling more controlled embolization of complex dAVFs. Retrospectively collected data were reviewed to assess the occlusion rates and clinical outcomes.
The dAVF was at a transverse sinus-sigmoid sinus junction in four patients, in the superior sagittal sinus in two, and in the tentorium in one. Five cases were Cognard type Ⅱb and two cases were Cognard type Ⅳ. All the patients were treated by transarterial Onyx injection via the main feeding vessel, combined with flow reduction in the other main feeding vessel using a balloon catheter. Complete occlusion was achieved in six patients and elimination of cerebral venous reflux was achieved in all the patients. There were no immediate or delayed post-interventional complications.
Transarterial Onyx embolization of dAVF using the damp-and-push technique is safe and yields a high complete occlusion rate.
共聚物（Onyx）栓塞术是治疗硬脑膜动静脉瘘（dAVF）的一种有效方法，然而，一些dAVF具有多条高流量供血血管，导致栓塞不充分。对于此类患者的治疗，我们开发了一种新型的流量控制技术，即“阻尼-推送技术”。本研究的目的是评估该技术的技术效率和安全性。
2016年至2019年间，7例被诊断为颅内dAVF的患者采用阻尼-推送技术经动脉进行Onyx栓塞治疗。该技术旨在使用球囊导管在除注入Onyx的血管之外的主要供血血管中减少分流部位的血流，从而使Onyx更好地渗透，并实现对复杂dAVF更可控的栓塞。回顾性收集的数据用于评估闭塞率和临床结果。
4例患者的dAVF位于横窦-乙状窦交界处，2例位于上矢状窦，1例位于小脑幕。5例为CognardⅡb型，2例为CognardⅣ型。所有患者均通过经动脉向主要供血血管注入Onyx，并联合使用球囊导管减少另一主要供血血管的血流进行治疗。6例患者实现了完全闭塞，所有患者均消除了脑静脉反流。没有立即或延迟的介入后并发症。
使用阻尼-推送技术经动脉对dAVF进行Onyx栓塞是安全的，并且完全闭塞率高。
