• Leonardo Renieri, Arturo Consoli, Giulia Scarpini, Giulia Grazzini, Sergio Nappini, and Salvatore Mangiafico.
• Interventional Neuroradiology Unit, Careggi University Hospital, Florence, Italy. leonardo.renieri@hotmail.it
• Neurosurgery. 2013 Jan 1;72(1):92-8; discussion 98.

BackgroundArteriovenous malformation (AVM) treatment is multidisciplinary, and the patient may undergo embolization, neurosurgery, or radiosurgery combined. Great improvement in endovascular techniques was provided by the introduction of Onyx with different kinds of approach.ObjectiveTo evaluate the efficacy and the safety of Onyx embolization of brain AVMs with the double arterial catheterization technique (DACT).MethodsThis was a retrospective study. From January 2006 until June 2011, 61 AVMs eligible for the DACT were treated. Forty-one of the 61 AVMs were treated with single arterial catheterization technique and 20 of 61 with DACT; patient age and Spetzler-Martin AVM grade were similar in the 2 groups.ResultsIn the DACT group, we obtained complete occlusion of the nidus in all small AVMs, whereas in the single arterial catheterization technique group, we obtained complete occlusion in only 1 of the 36% of the cases. Among the medium-size AVMs, there were no significant differences in the 2 groups, but we performed fewer procedures per patient when we used the DACT (1.4 vs 2.2). In the DACT group, we observed fewer hemorrhagic complications (3.4% vs 12.5% per procedure) and lower morbidity (5% vs 7% per patient) and mortality (0% vs 2.4%) rates.ConclusionThe DACT in multifeeder AVMs may lead to a higher occlusion rate of the nidus for small AVMs and reduce the number of procedures, ensuring a higher standard of safety because of the possibility of managing the progression of Onyx into venous drainage.

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