Safety of the apollo onyx delivery microcatheter for embolization of brain arteriovenous malformations: Results from a prospective post-market study

Philip M. Meyers, Johanna T. Fifi, Kevin M. Cockroft, Timothy R. Miller, Curtis A. Given, Ali R. Zomorodi, Bharathi D. Jagadeesan, Maxim Mokin, Peter Kan, Tom L. Yao, Orlando Diaz, Daniel Huddle, Richard J. Bellon, Joshua Seinfeld, Adam J. Polifka, David Fiorella, Rohan V. Chitale, Peter Kvamme, Jay T. Morrow, Justin SingerAjay K. Wakhloo, Ajit S. Puri, Vivek R. Deshmukh, Ricardo A. Hanel, L. Fernando Gonzalez, Henry H. Woo, Mohammad Ali Aziz-Sultan

Research output: Contribution to journalReview articlepeer-review

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.

Original languageEnglish (US)
Article number016830
JournalJournal of neurointerventional surgery
DOIs
StateAccepted/In press - 2020
Externally publishedYes

Keywords

  • Arteriovenous malformation
  • Catheter
  • Device
  • Liquid embolic material
  • Vascular malformation

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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