Onyx膠由次乙烯醇異分子聚合物（EVOH）、二甲基亞砜（DMSO）和鉭粉混合而成，是一種非粘性栓塞劑，有Onyx18（6%）和Onyx34（8%）可用于腦AVM栓塞。

以下內(nèi)容選自《Handbook of Cerebrovascular Disease and Neurointerventional Technique》。

Onyx? embolization technique

Onyx膠栓塞技術(shù)

(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，將數(shù)支Onyx膠放在自動搖晃器上搖晃至少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).

經(jīng)動脈途徑栓塞的微導(dǎo)管超選技術(shù)與應(yīng)用NBCA膠栓塞類似，只是要選用DMSO相容的微導(dǎo)管，如導(dǎo)絲導(dǎo)引微導(dǎo)管Rebar，或更柔軟的Marathon。（Echelon-10也不錯，Rebar我沒有在畸形栓塞中用過，Marathon還是最常用）

(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能夠進(jìn)入超選造影和巴比妥注射時的不易預(yù)測的部位，provocative試驗(yàn)可能造成假性結(jié)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.

應(yīng)用微導(dǎo)管行超選造影確認(rèn)微導(dǎo)管的位置是否正確。選擇的工作角度要能夠顯示微導(dǎo)管頭端，微導(dǎo)管頭端遠(yuǎn)端的供血動脈的所有彎曲，微導(dǎo)管頭端近端的正常分支，以及微導(dǎo)管頭端是否楔入了供血動脈內(nèi)。

(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?.

在超選造影上仔細(xì)計算從動脈端至靜脈端的時間，分析要注入Onyx部位的供血動脈、畸形血管團(tuán)和引流靜脈的形態(tài)學(xué)結(jié)構(gòu)。

(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.

根據(jù)供血動脈的粗細(xì)和動靜脈瘺的成分的多少來選擇Onyx的濃度。較粗的供血動脈，瘺的成分較多，就選用濃度稍高的Onyx 34；較細(xì)的供血動脈，瘺的成分較少，就選用濃度稍低的Onyx 18。

(g) Using the proper syringe supplied by ev3, draw up 1 mL of DMSO.

應(yīng)用ev3公司提供的專用的注射器分別抽吸DMSO和Onyx。使用Onyx注射器的正確方法見圖示。

(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.

在空白路圖下，緩慢注射Onyx膠，速度大約0.16ml/min。由于DMSO有毒性，超過0.3ml/min的注射速度可能造成血管的損傷。

(i) Continue injecting Onyx? as long as it is flowing forward into desired areas of the abnormal vessels.

繼續(xù)注射Onyx膠，使它盡量向期望的異常血管區(qū)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.

如果發(fā)生了沿微導(dǎo)管的返流，進(jìn)入了靜脈的近端，或返流到其他動脈分支，就停止注射15s。如果Onyx持續(xù)向不期望的區(qū)域注入，就暫停注射15-30s后再重新開始注射。如果Onyx流向另一個期望的區(qū)域，就繼續(xù)緩慢注射。

(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.

不時重新給予空白路圖，能夠更清楚地顯示新注入的膠，而不受原來注入的膠的干擾。

(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.

如果不確定注入的膠是否達(dá)到期望的結(jié)果，就通過導(dǎo)引導(dǎo)管做造影。造影能夠顯示供血動脈和畸形血管團(tuán)是否還需要繼續(xù)栓塞。

(m) The Onyx? injection should be done patiently and may take several minutes.

Onyx注射需要很耐心，可持續(xù)數(shù)分鐘。

(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.

沿著微導(dǎo)管頭端的少許返流是不用擔(dān)心的，因?yàn)镺nyx是非粘性膠。盡量避免返流的長度大于1cm，畢竟還是有粘管的可能性。

(o) Do not pause the injection for more than 2 min, for the Onyx? may solidify and clog the microcatheter.

不要暫停注射超過2min，Onyx膠可能凝固，從而堵塞微導(dǎo)管。

(p) Never try to inject against resistance. A clogged microcatheter may burst if the injection continues.

有阻力時不要強(qiáng)行再推注，可能造成微導(dǎo)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.

如果期望的區(qū)域已經(jīng)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，緩慢而持續(xù)地向后拔除微導(dǎo)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.

一旦微導(dǎo)管從導(dǎo)引導(dǎo)管中拔出，檢查導(dǎo)引導(dǎo)管的Y閥有無殘余的Onyx顆粒，沖洗三通，Y閥和導(dǎo)引導(dǎo)管。

(s) Once the guidecatheter is thoroughly inspected and flushed, perform a follow-up arteriogram to ensure that the desired result has been obtained.

仔細(xì)檢查導(dǎo)引導(dǎo)管后，行造影檢查確認(rèn)栓塞效果。