Safety of the APOLLO Onyx delivery microcatheter for embolization of brain arteriovenous malformations: results from a prospective post-market study

J Neurointerv Surg. 2021 Oct;13(10):935-941. doi: 10.1136/neurintsurg-2020-016830. Epub 2021 Feb 1.

Abstract

Background: Catheter retention and difficulty in retrieval have been observed during embolization of brain arteriovenous malformations (bAVMs) with the Onyx liquid embolic system (Onyx). The Apollo Onyx delivery microcatheter (Apollo) is a single lumen catheter designed for controlled delivery of Onyx into the neurovasculature, with a detachable distal tip to aid catheter retrieval. This study evaluates the safety of the Apollo for delivery of Onyx during embolization of bAVMs.

Methods: This was a prospective, non-randomized, single-arm, multicenter, post-market study of patients with a bAVM who underwent Onyx embolization with the Apollo between May 2015 and February 2018. The primary endpoint was any catheter-related adverse event (AE) at 30 days, such as unintentional tip detachment or malfunction with clinical sequelae, or retained catheter. Procedure-related AEs (untoward medical occurrence, disease, injury, or clinical signs) and serious AEs (life threatening illness or injury, permanent physiological impairment, hospitalization, or requiring intervention) were also recorded.

Results: A total of 112 patients were enrolled (mean age 44.1±17.6 years, 56.3% men), and 201 Apollo devices were used in 142 embolization procedures. The mean Spetzler-Martin grade was 2.38. The primary endpoint was not observed (0/112, 0%). The catheter tip detached during 83 (58.5%) procedures, of which 2 (2.4%) were unintentional and did not result in clinical sequelae. At 30 days, procedure related AEs occurred in 26 (23.2%) patients, and procedure-related serious AEs in 12 (10.7%). At 12 months, there were 3 (2.7%) mortalities, including 2 (1.8%) neurological deaths, none of which were device-related.

Conclusion: This study demonstrates the safety of Apollo for Onyx embolization of bAVMs.

Clinical trial registration: CNCT02378883.

Keywords: arteriovenous malformation; catheter; device; liquid embolic material; vascular malformation.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Brain
  • Dimethyl Sulfoxide / adverse effects
  • Embolization, Therapeutic* / adverse effects
  • Female
  • Humans
  • Intracranial Arteriovenous Malformations* / diagnostic imaging
  • Intracranial Arteriovenous Malformations* / therapy
  • Male
  • Middle Aged
  • Polyvinyls / adverse effects
  • Prospective Studies
  • Treatment Outcome

Substances

  • Polyvinyls
  • Dimethyl Sulfoxide

Associated data

  • ClinicalTrials.gov/NCT02378883