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Endovascular Balloon-Assisted Embolization of Intracranial and Cervical Arteriovenous Malformations Using Dual-Lumen Coaxial Balloon Microcatheters and Onyx: Initial Experience

Jagadeesan, Bharathi D. MD*,‡; Grigoryan, Mikayel MD§; Hassan, Ameer E. DO§; Grande, Andrew W. MD*,‡,§; Tummala, Ramachandra P. MD*,‡,§

doi: 10.1227/NEU.0000000000000186
Technique Assessment

BACKGROUND: Ethylene vinyl alcohol copolymer (Onyx) is widely used for the embolization of arteriovenous malformations (AVMs) of the brain, head, and neck. Balloon-assisted Onyx embolization may provide additional unique advantages in the treatment of AVMs in comparison with traditional catheter-based techniques.

OBJECTIVE: To report our initial experience in performing balloon-assisted AVM embolization for brain and neck AVMs with the use of the new Scepter-C and Scepter-XC coaxial dual-lumen balloon microcatheters.

METHODS: Balloon-assisted transarterial embolization was performed in a series of 7 patients with AVMs (4 with brain AVMs, 1 with a dural arteriovenous fistula, and 2 with neck AVMs) by using Onyx delivered through the lumen of Scepter-C or Scepter XC coaxial balloon microcatheters. Following the initial balloon-catheter navigation into a feeding artery and the subsequent inflation of the balloon, the embolization was performed by using Onyx 18, Onyx 34, or both.

RESULTS: A total of 12 embolization sessions were performed via 17 arterial feeders in these 7 patients. In 1 patient, there was an arterial perforation from the inflation of the balloon; in all others, the embolization goals were successfully achieved with no adverse events.

CONCLUSION: The balloon microcatheters showed excellent navigability, and there were no problems with retrieval or with the repeated inflation and deflation of the balloons. A proximal Onyx plug, which is crucial in many AVM embolizations, was not necessary with this technique. Additionally, fluoroscopy and procedural times seemed lower with this technique compared with conventional embolization methods.

ABBREVIATION: AVM, arteriovenous malformation

*Department of Radiology;

Department of Neurosurgery;

§Department of Neurology, University of Minnesota, Minneapolis, Minnesota

Correspondence: Bharathi D. Jagadeesan, MD, Department of Radiology: B226 E, MMC 292, Mayo Memorial Building, 420 Delaware St SE, Minneapolis, MN 55455. E-mail:

Received July 19, 2012

Accepted February 14, 2013

Copyright © by the Congress of Neurological Surgeons