Onyx embolization for dural arteriovenous fistulas: a multi-institutional study

Consortium for Dural Arteriovenous Fistula Outcomes Research , Yangchun Li, Stephanie H Chen, Ridhima Guniganti, Akash P Kansagra, Jay F Piccirillo, Ching-Jen Chen, Thomas Buell, Jason P Sheehan, Dale Ding, Giuseppe Lanzino, Waleed Brinjikji, Louis J Kim, Michael R Levitt, Isaac Josh Abecassis, Diederik O Bulters, Andrew Durnford, W Christopher Fox, Adam J Polifka, Bradley A GrossSamir Sur, David J McCarthy, Dileep R Yavagal, Eric C Peterson, Minako Hayakawa, Colin Derdeyn, Edgar A Samaniego, Sepideh Amin-Hanjani, Ali Alaraj, Amanda Kwasnicki, Fady T Charbel, J Marc C van Dijk, Adriaan Re Potgieser, Junichiro Satomi, Yoshiteru Tada, Adib Abla, Ryan Phelps, Rose Du, Pui Man Rosalind Lai, Gregory J Zipfel, Robert M Starke*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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BACKGROUND: Although the liquid embolic agent, Onyx, is often the preferred embolic treatment for cerebral dural arteriovenous fistulas (DAVFs), there have only been a limited number of single-center studies to evaluate its performance.

OBJECTIVE: To carry out a multicenter study to determine the predictors of complications, obliteration, and functional outcomes associated with primary Onyx embolization of DAVFs.

METHODS: From the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database, we identified patients who were treated for DAVF with Onyx-only embolization as the primary treatment between 2000 and 2013. Obliteration rate after initial embolization was determined based on the final angiographic run. Factors predictive of complete obliteration, complications, and functional independence were evaluated with multivariate logistic regression models.

RESULTS: A total 146 patients with DAVFs were primarily embolized with Onyx. Mean follow-up was 29 months (range 0-129 months). Complete obliteration was achieved in 80 (55%) patients after initial embolization. Major cerebral complications occurred in six patients (4.1%). At last follow-up, 84% patients were functionally independent. Presence of flow symptoms, age over 65, presence of an occipital artery feeder, and preprocedural home anticoagulation use were predictive of non-obliteration. The transverse-sigmoid sinus junction location was associated with fewer complications, whereas the tentorial location was predictive of poor functional outcomes.

CONCLUSIONS: In this multicenter study, we report satisfactory performance of Onyx as a primary DAVF embolic agent. The tentorium remains a more challenging location for DAVF embolization, whereas DAVFs located at the transverse-sigmoid sinus junction are associated with fewer complications.

Original languageEnglish
Number of pages7
JournalJournal of Neurointerventional Surgery
Publication statusPublished - 25-Feb-2021


  • fistula
  • liquid embolic material
  • complication
  • hemorrhage

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