China
Africa
Explore chapters and articles related to this topic
Arteriovenous malformations: Evaluation and treatment
Published in Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki, Handbook of Venous and Lymphatic Disorders, 2017
Onyx has several advantages over glue (nBCA) for the embolization of AVMs. It is less adhesive and polymerizes more slowly than glue. The microcatheters are rarely glued into the nidus and consequently make intranidal injection more controllable, resulting in a much more satisfactory result. In addition, Onyx carries a much lower risk of pulmonary embolism compared to the other emboloagents.
The promise of oncolytic viral therapy for the treatment of peritoneal surface malignancies
Published in Wim P. Ceelen, Edward A. Levine, Intraperitoneal Cancer Therapy, 2015
John H. Stewart, Lauren Gillory
Several clinical trials of oncolytic adenovirus therapies have been reported [19,24,25]. The ONYX-015 (Pfizer Corp., Groton, CT) adenovirus was the first replication-selective oncolytic adenovirus used in clinical trials [26,27]. This oncolytic virus, which contains a deletion of the gene encoding the p53-inactivating protein E1B, specifically kills tumor cells with p53 mutations [28]. To date, more than 18 clinical trials have been conducted with ONYX-015 against a variety of cancers, including colorectal and ovarian carcinomas [19,29]. However, the antitumor efficacy of ONYX-015 as a single agent was disappointing in the majority of these trials [24,30].
Considerations regarding feasibility, safety, and efficacy of N-butyl cyanoacrylate (n-BCA) and Onyx embolization for the treatment of venous malformations
Published in Byung-Boong Lee, Peter Gloviczki, Francine Blei, Jovan N. Markovic, Vascular Malformations, 2019
Jovan N. Markovic, Cynthia K. Shortell
Onyx is a nonadhesive liquid embolic agent consisting of ethylene vinyl alcohol (EVOH) copolymer dissolved in various concentrations of dimethyl sulfoxide (DMSO).7 To achieve adequate radio-opacity for visualization under fluoroscopy, this mixture is suspended in micronized tantalum powder. Onyx is commercially available in two concentrations: Onyx 18 (6% EVOH) and Onyx 34 (8% EVOH).7 Onyx 18 has lower viscosity and will travel more distally and penetrate deeper into the nidus compared to Onyx 34.7 With both concentrations, final solidification occurs within 5 minutes following intravascular injection.7 Currently, Onyx is FDA approved for its use in the treatment of intracranial arteriovenous malformations, and it is used for the treatment of VMs as an “off-label” agent. Following intraluminal injection and contact with blood, DMSO rapidly diffuses from the mixture, which leads to in situ precipitation and causes solidification of the polymer, which in turn forms an embolus without adhesion to the vascular endothelium.7 Due to its biochemical characteristics, Onyx was primarily used for the treatment of intracranial arteriovenous malformations. It is worth emphasizing that the cases of unexpected intraoperative flammability and combustion associated with Onyx (mixed with micronized tantalum [Ta] as radiopacifier) were reported when this embolic agent was used in conjunction with the mono-polar electro-cautery in the management of intracranial arteriovenous fistula.8 Schirmer et al. recommend to rely on low- to medium-energy bipolar electrocautery when used near the Ta-opacified Onyx to mitigate this risk.8
Migration of lipiodol into lateral ventricles after embolization of cerebral arteriovenous malformation: a case report
Published in British Journal of Neurosurgery, 2023
Mamoru Murakami, Gaku Fujiwara, Daisuke Maruyama, Yujiro Komaru, Nobukuni Murakami
Onyx liquid embolic system (Medtronic, Inc) is less adhesive, polymerizes slowly, and has been available since 2005 in the USA; however, it has been approved for use in patients only for pre-surgical resection of AVM in Japan since 2009. In this case, we did not schedule resection of the nidus because it was small and inside of the left temporal lobe, which is the area of the uncus or hippocampus. This is the reason we selected NBCA instead of Onyx for embolization. Histopathological analysis of AVM after embolization with Onyx was previously reported, and Onyx was found to penetrate much smaller vessels than NBCA. Recanalization was noted in 4 (18.2%) of 22 specimens after Onyx embolization, especially in cases with more than 42 days from resection to embolization of the AVM.3 This study raised questions about the performance of occlusion after embolization. If we had used Onyx in this case, such a complication may not have occurred, however, in case of the cast of Onyx had been exposed to the CSF of lateral ventricles a couple days after embolization, it was unclear how the chemical reaction occurred.
A technology evaluation of the Onyx Frontier drug-eluting stent
Published in Expert Opinion on Drug Delivery, 2023
Pier Pasquale Leone, Manaf Assafin, Andrea Scotti, Maday Gonzalez, Andrea Mignatti, Kathryn Dawson, Judah Rauch, Asma Khaliq, Dimitrios Bliagos, Azeem Latib
Numerous observational and randomized studies evaluating the performance of ZES have been conducted, with more than 30,000 patients treated so far. The RESOLUTE All Comers [39] was the first trial including patients with CAD and few exclusion criteria treated with ZES, and the similar safety and efficacy of ZES vs. DP- and BP-DES were later confirmed also in additional large randomized clinical trials [40–44] and cohort studies [45]. For practical purposes and clinical relevance, this section will largely focus on Resolute Onyx. Indeed, Onyx Frontier’s resemblance to its predecessor, except for the delivery system advancements, granted inheritance of most of its clinical applications. Given the first world’s implantation on May 31,st 2022, findings from studies on Resolute Onyx can be prudently extrapolated to this latest iteration. Overall, the exclusive performance of Resolute Onyx has been evaluated in two dedicated randomized trials and six observational cohorts (Table 3) [37,46–55]. We will first review results from studies conducted on an all-comer population, and considerations from studies in specific clinical and anatomical settings will follow.
Transvenous embolization of bilateral indirect carotid-cavernous fistulas via a unilateral transorbital approach
Published in Orbit, 2021
Jacquelyn F. Laplant, Lauren H. Lim, Aaron S. Dumont, John D. Nerva
Percutaneous transorbital puncture has been shown to provide safe access to the CS via either direct needle puncture of the SOF or puncture of the confluence of veins anterior to the SOF (Figure 4).13,14 Once needle placement has been confirmed by venography, embolization commences with coils or liquid embolic material.3 Onyx embolization via transorbital puncture has been described for unilateral CCF.4,6-8 Onyx is a non-adhesive embolic agent that allows slow-controlled injection to penetrate the channels of the CS and fistulous connections and may be favored over coils due to septation of the CS and subsequent risk of incomplete embolization and fistula progression with potentially limited access for treatment.7 During infusion of Onyx, careful attention is given to inadvertent penetration into ICA branches, which could lead to distal embolization and stroke. As such, coil embolization can be considered to decrease this risk of stroke depending on the specific case and CCF anatomy.