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Safety of Onyx Transarterial Embolization of Skull Base Dural Arteriovenous Fistulas from Meningeal Branches of the External Carotids also Fed by Meningeal Branches of Internal Carotid or Vertebral Arteries

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Abstract

Purpose

To analyze the angiographic and clinical results of transarterial embolization with Onyx (Medtronic-Covidien, Irvine, CA) in dural arteriovenous fistulas (DAVFs) partially fed by arteries arising from the carotid siphon or the vertebral arteries.

Methods

We isolated 40 DAVFs supplied by either the tentorial artery of the internal carotid artery (ICA) or the posterior meningeal artery of the vertebral artery. These DAVFs were embolized with Onyx through the middle meningeal artery or the occipital artery. We reviewed the occurrence of reflux into the arteries of carotid or vertebral origin.

Results

In all the cases, reflux occurred into the first millimeters of the DAVF arterial feeders arising from carotid or vertebral arteries but slowly enough to be controlled by interruption of Onyx injection. Reflux was always minimal and Onyx never reached the ostium of the arteries. No cerebral ischemic complications occurred in our series.

Conclusion

The behavior of Onyx is clearly different from that of cyanoacrylate glue, resulting in superior control during injection. Reflux into arteries arising from the ICA or vertebral artery during DAVF treatment always carries a risk of unintentional non-target embolization of normal cerebral vasculature but Onyx appears to be safe in this situation.

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Authors and Affiliations

  1. Diagnostic Imaging Department, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800, Vila Clementino, 04024-002, São Paulo, SP, Brazil

    Thiago G. Abud & Nitamar Abdala

  2. Interventional Neuroradiology, Hôpital Lariboisière, 2 rue Ambroise-Paré, 75010, Paris, France

    Thiago G. Abud, Emmanuel Houdart, Jean-Pierre Saint-Maurice & Andrew D. Nguyen

  3. Interventional Neuroradiology, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, Hemodinâmica Bloco A, 4th floor, 05651-901, São Paulo, SP, Brazil

    Thiago G. Abud & Carlos E. Baccin

  4. Interventional Neuroradiology, Campus Universitário, 14048-900, Monte Alegre, SP, Brazil

    Daniel G. Abud

Authors
  1. Thiago G. Abud
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  2. Emmanuel Houdart
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  3. Jean-Pierre Saint-Maurice
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  4. Daniel G. Abud
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  6. Andrew D. Nguyen
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  7. Nitamar Abdala
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Corresponding author

Correspondence to Thiago G. Abud.

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Conflict of interest

T.G. Abud, E. Houdart, J.-P. Saint-Maurice, D.G. Abud, C.E. Baccin, A.D. Nguyen and N. Abdala declare that they have no competing interests.Please confirm or correct the statement on the conflict of interest.

Ethical standards

This study was approved by the research ethics committee of Universidade Federal de São Paulo (UNIFESP), registration number 0534/2016, protocol number 1.550.934. Informed consent was obtained from all patients. All procedures were in accordance with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Additional information

Contributors

Thiago G. Abud: analysis and interpretation of cases, writing the article, figure editing.

Emmanuel Houdart: execution of the procedures and clinical follow-up.

Jean-Pierre Saint-Maurice: execution of the procedures and clinical follow-up.

Daniel G. Abud: analysis and interpretation of cases.

Carlos E. Baccin: writing the article.

Andrew D. Nguyen: writing the article.

Nitamar Abdala: supervision and critical revision of the article.

All authors have approved the final version.

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Abud, T.G., Houdart, E., Saint-Maurice, JP. et al. Safety of Onyx Transarterial Embolization of Skull Base Dural Arteriovenous Fistulas from Meningeal Branches of the External Carotids also Fed by Meningeal Branches of Internal Carotid or Vertebral Arteries. Clin Neuroradiol 28, 579–584 (2018). https://doi.org/10.1007/s00062-017-0615-7

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  • DOI: https://doi.org/10.1007/s00062-017-0615-7

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