• Bharathi D Jagadeesan, Mikayel Grigoryan, Ameer E Hassan, Andrew W Grande, and Ramachandra P Tummala.
• 1Department of Radiology, University of Minnesota 2Department of Neurosurgery, University of Minnesota 3Department of Neurology, University of Minnesota.
• Neurosurgery. 2013 Feb 25.

BackgroundEthylene vinyl alcohol co-polymer (Onyx) is widely used for the embolization of arteriovenous malformations of the brain, head, and neck. Balloon-assisted Onyx embolization may provide additional unique advantages in the treatment of AVMs when compared to traditional catheter-based techniques. ObjectiveTo report our initial experience in performing balloon-assisted AVM embolization for brain and neck AVMs using the new Scepter-C and Scepter-XC co-axial dual lumen balloon microcatheters. MethodsBalloon-assisted trans-arterial embolization was carried out in a series of seven patients with AVMs (4 with brain AVMs, one with a dural AVF, and two with neck AVMs) using Onyx delivered through the lumen of Scepter-C or Scepter XC co-axial balloon microcatheters. Following the initial balloon-catheter navigation into a feeding artery and the subsequent inflation of the balloon, the embolization was performed using Onyx 18, Onyx 34, or both. ResultsA total of twelve embolization sessions were performed via 17 arterial feeders in these 7 patients. In one patient, there was an arterial perforation from inflation of the balloon; in all others, the embolization goals were successfully achieved with no adverse events. ConclusionThe 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 to conventional embolization methods.

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