Onyx Liquid Embolic Agent: Basic Knowledge for Its Use in Interventional Neuroradiology

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Onyx (Medtronic, Minneapolis, MN, USA) is a non-adhesive liquid embolic agent composed of an ethylene vinyl alcohol (EVOH) copolymer dissolved in dimethyl sulfoxide (DMSO). Onyx is explicitly designed for use in interventional neuroradiological procedures. Onyx’s unique formulation allows controlled delivery and solidification within the target vessel, providing durable occlusion of abnormal vascular structures such as arteriovenous malformations and dural arteriovenous fistulas. This report reviews the basic understanding of the use of Onyx in interventional neuroradiology. The hydrophilic properties of the agent facilitate its smooth delivery through microcatheters, ensuring precise navigation and deposition within vascular malformations under fluoroscopic guidance. When Onyx was injected into the target vessel, the vessel was embolized as the solvent (DMSO) diffused into the blood and EVOH precipitated to form a durable cast. Onyx liquid embolic agents substantially advance the endovascular treatment of intracranial vascular lesions.