Transarterial coil-augmented Onyx embolization for brain arteriovenous malformation. Technique and experience in 22 consecutive patients

Interv Neuroradiol. 2014 Jan-Feb;20(1):83-90. doi: 10.15274/INR-2014-10012. Epub 2014 Feb 10.


Onyx has been widely adopted for the treatment of arteriovenous malformations (AVMs). However, its control demands operators accumulate a considerable learning curve. We describe our initial experience using a novel injection method for the embolization of AVMs. We retrospectively reviewed the data of all 22 patients with brain AVMs (12 men, 10 women; age range, 12-68 years; mean age, 43.2 years) treated by the transarterial coil-augmented Onyx injection technique. The size of the AVMs ranged from 25 mm to 70 mm (average 35.6 mm). The technical feasibility of the procedure, procedure-related complications, angiographic results, and clinical outcome were evaluated. In every case, endovascular treatment (EVT) was completed. A total of 31 sessions were performed, with a mean injection volume of 6.1 mL (range, 1.5-16.0 mL). An average of 96.7% (range 85%-100%) estimated size reduction was achieved, and 18 AVMs could be completely excluded by EVT alone. The results remained stable on follow-up angiograms. A procedural complication occurred in one patient, with permanent mild neurologic deficit. Our preliminary series demonstrated that the coil-augmented Onyx injection technique is a valuable adjunct achieving excellent nidal penetration and improving the safety of the procedure.

Keywords: Onyx; arteriovenous malformation; coil; embolization; endovascular treatment.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Arteriovenous Fistula / diagnostic imaging*
  • Arteriovenous Fistula / therapy*
  • Cerebral Arteries / surgery
  • Child
  • Combined Modality Therapy / instrumentation
  • Combined Modality Therapy / methods
  • Dimethyl Sulfoxide / therapeutic use*
  • Embolization, Therapeutic / instrumentation*
  • Embolization, Therapeutic / methods*
  • Female
  • Hemostatics / therapeutic use
  • Humans
  • Intracranial Arteriovenous Malformations / diagnostic imaging*
  • Intracranial Arteriovenous Malformations / therapy*
  • Male
  • Middle Aged
  • Polyvinyls / therapeutic use*
  • Radiography
  • Recovery of Function
  • Treatment Outcome
  • Young Adult


  • Hemostatics
  • Onyx copolymer
  • Polyvinyls
  • Dimethyl Sulfoxide