Embolization of Brain Arteriovenous Malformations with Versus without Onyx before Stereotactic Radiosurgery

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

doi:10.1093/neuros/nyaa370

Embolization of Brain Arteriovenous Malformations with Versus without Onyx before Stereotactic Radiosurgery

Ching Jen Chen, Dale Ding, Cheng Chia Lee, Kathryn N. Kearns, I. Jonathan Pomeraniec, Christopher P. Cifarelli, David E. Arsanious, Roman Liscak, Jaromir Hanuska, Brian J. Williams, Mehran B. Yusuf, Shiao Y. Woo, Natasha Ironside, Ronald E. Warnick, Daniel M. Trifiletti, David Mathieu, Monica Mureb, Carolina Benjamin, Douglas Kondziolka, Caleb E. FelicianoRafael Rodriguez-Mercado, Kevin M. Cockroft, Scott Simon, Heath B. Mackley, Samer G. Zammar, Neel T. Patel, Varun Padmanaban, Nathan Beatson, Anissa Saylany, John Lee, Jason P. Sheehan

Radiation Oncology

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

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.

Original language	English (US)
Pages (from-to)	366-374
Number of pages	9
Journal	Neurosurgery
Volume	88
Issue number	2
DOIs	https://doi.org/10.1093/neuros/nyaa370
State	Published - Feb 1 2021

Keywords

Arteriovenous malformation
Embolization
Endovascular
Stereotactic radiosurgery
Stroke

ASJC Scopus subject areas

Surgery
Clinical Neurology

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10.1093/neuros/nyaa370

Cite this

Chen, C. J., Ding, D., Lee, C. C., Kearns, K. N., Jonathan Pomeraniec, I., Cifarelli, C. P., Arsanious, D. E., Liscak, R., Hanuska, J., Williams, B. J., Yusuf, M. B., Woo, S. Y., Ironside, N., Warnick, R. E., Trifiletti, D. M., Mathieu, D., Mureb, M., Benjamin, C., Kondziolka, D., ... Sheehan, J. P. (2021). Embolization of Brain Arteriovenous Malformations with Versus without Onyx before Stereotactic Radiosurgery. Neurosurgery, 88(2), 366-374. https://doi.org/10.1093/neuros/nyaa370

Chen, CJ, Ding, D, Lee, CC, Kearns, KN, Jonathan Pomeraniec, I, Cifarelli, CP, Arsanious, DE, Liscak, R, Hanuska, J, Williams, BJ, Yusuf, MB, Woo, SY, Ironside, N, Warnick, RE, Trifiletti, DM, Mathieu, D, Mureb, M, Benjamin, C, Kondziolka, D, Feliciano, CE, Rodriguez-Mercado, R, Cockroft, KM, Simon, S, Mackley, HB, Zammar, SG, Patel, NT, Padmanaban, V, Beatson, N, Saylany, A, Lee, J & Sheehan, JP 2021, 'Embolization of Brain Arteriovenous Malformations with Versus without Onyx before Stereotactic Radiosurgery', Neurosurgery, vol. 88, no. 2, pp. 366-374. https://doi.org/10.1093/neuros/nyaa370

@article{c0f2fb5d5a3e417497b9d130c7a90e87,

title = "Embolization of Brain Arteriovenous Malformations with Versus without Onyx before Stereotactic Radiosurgery",

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",

author = "Chen, {Ching Jen} and Dale Ding and Lee, {Cheng Chia} and Kearns, {Kathryn N.} and {Jonathan Pomeraniec}, I. and Cifarelli, {Christopher P.} and Arsanious, {David E.} and Roman Liscak and Jaromir Hanuska and Williams, {Brian J.} and Yusuf, {Mehran B.} and Woo, {Shiao Y.} and Natasha Ironside and Warnick, {Ronald E.} and Trifiletti, {Daniel M.} and David Mathieu and Monica Mureb and Carolina Benjamin and Douglas Kondziolka and Feliciano, {Caleb E.} and Rafael Rodriguez-Mercado and Cockroft, {Kevin M.} and Scott Simon and Mackley, {Heath B.} and Zammar, {Samer G.} and Patel, {Neel T.} and Varun Padmanaban and Nathan Beatson and Anissa Saylany and John Lee and Sheehan, {Jason P.}",

note = "Publisher Copyright: Copyright {\textcopyright} 2020 by the Congress of Neurological Surgeons.",

year = "2021",

month = feb,

day = "1",

doi = "10.1093/neuros/nyaa370",

language = "English (US)",

volume = "88",

pages = "366--374",

journal = "Neurosurgery",

issn = "0148-396X",

publisher = "Lippincott Williams and Wilkins",

number = "2",

}

TY - JOUR

T1 - Embolization of Brain Arteriovenous Malformations with Versus without Onyx before Stereotactic Radiosurgery

AU - Chen, Ching Jen

AU - Ding, Dale

AU - Lee, Cheng Chia

AU - Kearns, Kathryn N.

AU - Jonathan Pomeraniec, I.

AU - Cifarelli, Christopher P.

AU - Arsanious, David E.

AU - Liscak, Roman

AU - Hanuska, Jaromir

AU - Williams, Brian J.

AU - Yusuf, Mehran B.

AU - Woo, Shiao Y.

AU - Ironside, Natasha

AU - Warnick, Ronald E.

AU - Trifiletti, Daniel M.

AU - Mathieu, David

AU - Mureb, Monica

AU - Benjamin, Carolina

AU - Kondziolka, Douglas

AU - Feliciano, Caleb E.

AU - Rodriguez-Mercado, Rafael

AU - Cockroft, Kevin M.

AU - Simon, Scott

AU - Mackley, Heath B.

AU - Zammar, Samer G.

AU - Patel, Neel T.

AU - Padmanaban, Varun

AU - Beatson, Nathan

AU - Saylany, Anissa

AU - Lee, John

AU - Sheehan, Jason P.

PY - 2021/2/1

Y1 - 2021/2/1

N2 - 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.

AB - 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.

KW - Arteriovenous malformation

KW - Embolization

KW - Endovascular

KW - Stereotactic radiosurgery

KW - Stroke

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U2 - 10.1093/neuros/nyaa370

DO - 10.1093/neuros/nyaa370

M3 - Article

C2 - 32860409

AN - SCOPUS:85100069513

SN - 0148-396X

VL - 88

SP - 366

EP - 374

JO - Neurosurgery

JF - Neurosurgery

IS - 2

ER -

Embolization of Brain Arteriovenous Malformations with Versus without Onyx before Stereotactic Radiosurgery

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