Article Figures & Data
Figures
- Fig 1.
Schematic drawing of the SONIC detachable tip. 1, Detachable distal part of the microcatheter. 2, Soluble DMSO glue (noncompatible) in the distal part of the connecting zone. 3, Compatible DMSO glue in the proximal part of the connecting zone. 4, Proximal part of the microcatheter. 5, The black line is the second (middle) marker at the detachment point. Reprinted with permission from B.H.
- Fig 2.
Patient with large AVM totally occluded in 1 session with 6.7 mL of Onyx. A, CTA depicting a right parietal AVM with S-M grade of 3. B, Angiography, lateral view of right common carotid artery injection demonstrating the lesion. C, Lateral view of the Onyx cast in the lesion. D, Angiography, lateral view of right carotid injection demonstrating complete occlusion of the lesion at the end of treatment. E and F, Anteroposterior and lateral views of angiography performed 6 months after treatment demonstrating complete obliteration of the lesion.
- Fig 3.
Patient with a large right parietal AVM (S-M grade of 3) that developed left hemiparesis after complete embolization of the lesion. Lateral view posterior circulation injection (A) and anteroposterior view of right ICA injection (B) demonstrating the lesion. C and D, Lateral and AP views of the right internal carotid artery injection at the end of the Onyx embolization showing complete occlusion of the arteriovenous malformation. E, Postprocedural CT demonstrating hematoma with mass effect milder than would be expected from the size. The patient was treated conservatively with clinical improvement. F and G, Follow-up angiography 6 months after treatment showing complete obliteration of the AVM.
Tables
Presenting Symptom No. Patients Bleeding 16 Seizures 14 Incidental 13 Total 43 AVM S-M Grade No. Patients % Complete Obliteration Using Embolization (n) Clinical Complications (of Endovascular Procedures) Surgery Radiosurgery 1 3 67% (2) 1 Elective 2 5 60% (3) 2 3 9 67% (6) 3 Intracerebral hemorrhage, 1 subarachnoid hemorrhage 2 Urgent 0 4 14 29% (4) 2 Intracerebral hemorrhage, 1 extravasation of Onyx 6 5 12 8% (1) 2 Elective 1 Total 43 Note:—Twenty-nine out of 43 patients have concluded endovascular treatments; the remaining 14 patients are scheduled for further endovascular treatments.
- Table 3:
Complications classified according to lesion location, grade, and amount of Onyx injected
AVM S-M Grade Location Amount of Onyx Injected Complication Clinical Treatment Outcome 3 Right frontoparietal 3.4 mL 1st Session Intracerebral hemorrhage due to rupture of a feeding artery while retrieving the microcatheter (Marathon) Immediate deterioration Urgent craniotomy AVM closed, severe disability 4 Right thalamic 2 mL 2nd Session Extravasation of contrast from small feeder due to puncture with guidewire Left hemiparesthesia Conservative Mostly resolved; left with mild hypoesthesia (good recovery) 4 Right frontal 7 mL 2nd Session Small intracerebral hemorrhage due to extravasation of Onyx from vessel Left hemiparesis Conservative Resolved in 3 months (good recovery) 3 Left temporal 5.3 mL 1st Session Subarachnoid hemorrhage due to forced retrieval of catheter from Onyx cast that passed SONIC third marker Dysphasia Conservative Mild dysphasia resolved within 6 months (good recovery) 4 Left parietal 2 mL 3rd Session Small intracerebral hemorrhage 2 days after treatment, most probably due to venous occlusion No new deficit Conservative (Good recovery) 3 Right parietal 6.7 mL 1st Session Small intracerebral hemorrhage due to venous congestion, after complete occlusion in 1 session (Fig 3) Left proprioception deficit Conservative Resolved in 2 weeks, complete occlusion on angio follow-up (good recovery) 3 Left fronto-opercular 4 mL 1st Session Intracerebral hemorrhage due to venous congestion, after complete occlusion in 1 session Seizure and right hemiparesis Urgent craniotomy for hematoma evacuation Mild short memory deficit (good recovery)
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