Document Detail


Comparison of N-butyl cyanoacrylate and onyx for the embolization of intracranial arteriovenous malformations: analysis of fluoroscopy and procedure times.
MedLine Citation:
PMID:  18728607     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Intracranial arteriovenous malformations (AVM) may be managed through staged preoperative embolization and resection. Two commonly used liquid embolics are N-butyl cyanoacrylate (nBCA; Cordis Microvascular, Inc., New Brunswick, NJ) and Onyx (ev3, Inc., Irvine, CA). We sought to compare the utility of these agents in terms of fluoroscopy and procedure times. METHODS: All intracranial AVMs embolized from 2002 to 2006 at the University of Florida were included in this study. Patients were stratified into three treatment groups: nBCA, Onyx, and patients who received both nBCA and Onyx during separate embolizations. Cohorts were compared by sex, age, Spetzler-Martin grade, AVM volume, fluoroscopy time, procedure time, surgical blood loss, and complications. RESULTS: A total of 182 embolizations were performed on 88 patients (nBCA, 60 patients and 106 procedures; Onyx, 20 patients and 43 procedures; and nBCA/Onyx, eight patients and 16 nBCA and 17 Onyx procedures). There were no significant differences in patient demographics, AVM volumes, and Spetzler-Martin grades. Mean fluoroscopy and procedure times were increased for Onyx (57 min; 2.6 h) compared with nBCA (37 min; 2.1 h) embolizations (P < 0.0001 and P = 0.001, respectively). Cumulative mean fluoroscopy time was increased for Onyx (135 min) and nBCA/Onyx (180 min) cohorts relative to nBCA (64 min; P < 0.0001). Cumulative mean procedure time was increased in the nBCA/Onyx group (10.4 h) compared with nBCA (3.7 h) and Onyx (5.4 h; P < 0.0001). Seventy patients (80%) underwent AVM resection. No significant differences in surgical blood loss or complication rates were observed among the cohorts. CONCLUSION: Onyx AVM embolization requires increased fluoroscopy and procedure times compared with nBCA. Further investigation is necessary to justify increased radiation exposure and procedure time associated with Onyx.
Authors:
Gregory J Velat; John F Reavey-Cantwell; Christopher Sistrom; David Smullen; Gregory L Fautheree; Jobyna Whiting; Stephen B Lewis; Robert A Mericle; Christopher S Firment; Brian L Hoh
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  63     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-08-27     Completed Date:  2009-03-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  ONS73-8; discussion ONS78-80     Citation Subset:  IM    
Affiliation:
Department of Neurological Surgery, University of Florida, Gainesville, Florida 32610, USA. gregory.velat@neurosurgery.ufl.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Cohort Studies
Dimethyl Sulfoxide / administration & dosage*,  chemistry
Embolization, Therapeutic / methods*
Enbucrilate / administration & dosage*,  chemistry
Female
Fluoroscopy / methods
Humans
Intracranial Arteriovenous Malformations / pathology,  therapy*
Male
Middle Aged
Polyvinyls / administration & dosage*,  chemistry
Prospective Studies
Time Factors
Chemical
Reg. No./Substance:
0/Onyx copolymer; 0/Polyvinyls; 6606-65-1/Enbucrilate; 67-68-5/Dimethyl Sulfoxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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