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Onyx胶由次乙烯醇异分子聚合物（EVOH）、二甲基亚砜（DMSO）和钽粉混合而成，是一种非粘性栓塞剂，有Onyx18（6%）和Onyx34（8%）可用于脑AVM栓塞。 以下内容选自《Handbook of Cerebrovascular Disease and Neurointerventional Technique》。 Onyx? embolization technique Onyx胶栓塞技术 (a) Have several vials of Onyx? (ev3, Irvine, CA) agitating in an automatic mixer for at least 30 min while performing other parts of the procedure. 在操作前，将数支Onyx胶放在自动摇晃器上摇晃至少30min。 (b) This transarterial technique is similar to the technique using n-BCA glue regarding the catheterization of the arterial feeder, except one must use a dimethylsulfoxide (DMSO)-compatible catheter such as the over the-wire type Rebar? (ev3,Irvine, CA) or more flexible Marathon? (ev3, Irvine, CA). 经动脉途径栓塞的微导管超选技术与应用NBCA胶栓塞类似，只是要选用DMSO相容的微导管，如导丝导引微导管Rebar，或更柔软的Marathon。（Echelon-10也不错，Rebar我没有在畸形栓塞中用过，Marathon还是最常用） (c) Note that provocative testing can give a false sense of security since Onyx? can easily find its way into places that may not be predicted by superselective angiography or barbiturate injections. 由于Onyx能够进入超选造影和巴比妥注射时的不易预测的部位，provocative试验可能造成假性结果。 (d) Confirm proper catheter positioning with a contrast injection via the microcatheter for a superselective arteriogram. Select a projection that shows the microcatheter tip and its relationship to any curves in the arterial feeder distal to the catheter tip, any normal branches proximal to it, and whether the tip is wedged. 应用微导管行超选造影确认微导管的位置是否正确。选择的工作角度要能够显示微导管头端，微导管头端远端的供血动脉的所有弯曲，微导管头端近端的正常分支，以及微导管头端是否楔入了供血动脉内。 (e) Study the superselective arteriogram carefully to measure the arteriovenous transit time,and to determine the morphology of the target arterial feeder and venous structure where you will deposit the Onyx?. 在超选造影上仔细计算从动脉端至静脉端的时间，分析要注入Onyx部位的供血动脉、畸形血管团和引流静脉的形态学结构。 (f) Select a pre-mixed viscosity of the agent depending on the size of the feeder and degree of arteriovenous shunting. Big feeders with fast flow need Onyx? 34 and small feeders or slower shunting should be treated with Onyx? 18. 根据供血动脉的粗细和动静脉瘘的成分的多少来选择Onyx的浓度。较粗的供血动脉，瘘的成分较多，就选用浓度稍高的Onyx 34；较细的供血动脉，瘘的成分较少，就选用浓度稍低的Onyx 18。 (g) Using the proper syringe supplied by ev3, draw up 1 mL of DMSO. 应用ev3公司提供的专用的注射器分别抽吸DMSO和Onyx。使用Onyx注射器的正确方法见图示。 (h) Using a blank roadmap mask, slowly inject the Onyx? under roadmap visualization at a rate of approximately 0.16 mL min?1.Rates of injection over 0.3 mL min?1 risk vascular injury due to DMSO toxicity. 在空白路图下，缓慢注射Onyx胶，速度大约0.16ml/min。由于DMSO有毒性，超过0.3ml/min的注射速度可能造成血管的损伤。 (i) Continue injecting Onyx? as long as it is flowing forward into desired areas of the abnormal vessels. 继续注射Onyx胶，使它尽量向期望的异常血管区域注入。 (j) If it refluxes along the catheter, passes into the proximal part of the vein, or refluxes into other arterial feeders,pause the injection for 15 s, then resume injecting. If the Onyx? continues to flow in the wrong direction, pause again for 15–30 s, then try again. If the Onyx? finds another, more desirable pathway, continue the slow injection. 如果发生了沿微导管的返流，进入了静脉的近端，或返流到其他动脉分支，就停止注射15s。如果Onyx持续向不期望的区域注入，就暂停注射15-30s后再重新开始注射。如果Onyx流向另一个期望的区域，就继续缓慢注射。 (k) It is often desirable to obtain a new mask for roadmap periodically. This subtracts out the already deposited embolic agent and makes the newly injected material easier to see. 不时重新给予空白路图，能够更清楚地显示新注入的胶，而不受原来注入的胶的干扰。 (l) If uncertain whether the injection is achieving the desired result, a contrast injection can be done via the guide catheter for a control angiogram. This will show if there is still portions of the feeding artery or nidus that should be occluded from this catheter position. 如果不确定注入的胶是否达到期望的结果，就通过导引导管做造影。造影能够显示供血动脉和畸形血管团是否还需要继续栓塞。 (m) The Onyx? injection should be done patiently and may take several minutes. Onyx注射需要很耐心，可持续数分钟。 (n) Some reflux back along the catheter tip is not a problem, due to the nonadhesive nature of the product. Avoid more than 1 cm of reflux, however, since even Onyx? may glue a microcatheter into the vessel. 沿着微导管头端的少许返流是不用担心的，因为Onyx是非粘性胶。尽量避免返流的长度大于1cm，毕竟还是有粘管的可能性。 (o) Do not pause the injection for more than 2 min, for the Onyx? may solidify and clog the microcatheter. 不要暂停注射超过2min，Onyx胶可能凝固，从而堵塞微导管。 (p) Never try to inject against resistance. A clogged microcatheter may burst if the injection continues. 有阻力时不要强行再推注，可能造成微导管爆裂。 (q) When adequate filling of the desired vascular spaces is achieved, or if the Onyx? repeatedly flows in the wrong direction, stop injecting, aspirate back on the syringe, and slowly, but steadily pull back on the microcatheter, disengage it from the deposited Onyx? and remove it. The heavy-duty catheters used for Onyx? canusually be pulled back on their own, without pulling the guide catheter as well. 如果期望的区域已经完全栓塞，或Onyx多次流入非期望的方向，就停止注射，抽吸注射器，缓慢而持续地向后拔除微导管。 (r) After the microcatheter is withdrawn from the guide catheter, examine the rotating hemostatic valve of the guiding catheter for any retained droplets of Onyx?,then aspirate and double flush the stopcock, rotating hemostatic valve, and guide-catheter. 一旦微导管从导引导管中拔出，检查导引导管的Y阀有无残余的Onyx颗粒，冲洗三通，Y阀和导引导管。 (s) Once the guidecatheter is thoroughly inspected and flushed, perform a follow-up arteriogram to ensure that the desired result has been obtained. 仔细检查导引导管后，行造影检查确认栓塞效果。 |
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