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. 2021 Jan 13;88(2):366-374.
doi: 10.1093/neuros/nyaa370.

Embolization of Brain Arteriovenous Malformations With Versus Without Onyx Before Stereotactic Radiosurgery

Ching-Jen Chen  1 , Dale Ding  2 , Cheng-Chia Lee  3 , Kathryn N Kearns  1 , I Jonathan Pomeraniec  1 , Christopher P Cifarelli  4 , David E Arsanious  4 , Roman Liscak  5 , Jaromir Hanuska  5 , Brian J Williams  2 , Mehran B Yusuf  6 , Shiao Y Woo  6 , Natasha Ironside  1 , Ronald E Warnick  7 , Daniel M Trifiletti  8 , David Mathieu  9 , Monica Mureb  10 , Carolina Benjamin  10 , Douglas Kondziolka  10 , Caleb E Feliciano  11 , Rafael Rodriguez-Mercado  11 , Kevin M Cockroft  12 , Scott Simon  12 , Heath B Mackley  13 , Samer G Zammar  12 , Neel T Patel  12 , Varun Padmanaban  12 , Nathan Beatson  14 , Anissa Saylany  14 , John Lee  14 , Jason P Sheehan  1
Affiliations

Embolization of Brain Arteriovenous Malformations With Versus Without Onyx Before Stereotactic Radiosurgery

Ching-Jen Chen et al. Neurosurgery. .

Abstract

Background: Embolization of brain arteriovenous malformations (AVMs) using ethylene-vinyl alcohol copolymer (Onyx) embolization may influence the treatment effects of stereotactic radiosurgery (SRS) differently than other embolysates.

Objective: To compare the outcomes of pre-SRS AVM embolization with vs without Onyx through a multicenter, retrospective matched cohort study.

Methods: We retrospectively reviewed International Radiosurgery Research Foundation AVM databases from 1987 to 2018. Embolized AVMs treated with SRS were selected and categorized based on embolysate usage into Onyx embolization (OE + SRS) or non-Onyx embolization (NOE + SRS) cohorts. The 2 cohorts were matched in a 1:1 ratio using de novo AVM features for comparative analysis of outcomes.

Results: The matched cohorts each comprised 45 patients. Crude AVM obliteration rates were similar between the matched OE + SRS vs NOE + SRS cohorts (47% vs 51%; odds ratio [OR] = 0.837, P = .673). Cumulative probabilities of obliteration were also similar between the OE + SRS vs NOE + SRS cohorts (subhazard ratio = 0.992, P = .980). Rates of post-SRS hemorrhage, all-cause mortality, radiation-induced changes, cyst formation, and embolization-associated complications were similar between the matched cohorts. Sensitivity analysis for AVMs in the OE + SRS cohort embolized with Onyx alone revealed a higher rate of asymptomatic embolization-associated complications in this subgroup compared to the NOE + SRS cohort (36% vs 15%; OR = 3.297, P = .034), but the symptomatic complication rates were similar.

Conclusion: Nidal embolization using Onyx does not appear to differentially impact the outcomes of AVM SRS compared with non-Onyx embolysates. The embolic agent selected for pre-SRS AVM embolization should reflect both the experience of the neurointerventionalist and target of endovascular intervention.

Keywords: Arteriovenous malformation; Embolization; Endovascular; Stereotactic radiosurgery; Stroke.

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