Use of intracranial stenting to secure unstable liquid embolic casts in wide-neck sidewall intracranial aneurysms.

Abstract

BACKGROUND:

Onyx HD 500 (eV3, Irvine, CA) is a high-viscosity liquid embolic agent that has recently been approved in the United States as a humanitarian use device for the treatment of wide-neck sidewall intracranial aneurysms. Preliminary evidence suggest that liquid embolic agents can provide improved angiographic results with a lower incidence of recanalization compared to coil embolization.

OBJECTIVE:

To report unstable Onyx casts and how to deal with them.

METHODS:

We report 4 cases of intracranial aneurysms treated with Onyx HD 500 in which, after the aneurysm was successfully obliterated, the Onyx cast was noted to have 1 of 2 types of embolic cast instability. In all 4 cases, an intracranial stent or vascular reconstruction device (VRD) was placed across the Onyx cast at the aneurysm orifice and the cast was stabilized.

CONCLUSION:

This series is the first published description of Onyx HD 500 aneurysm cast instability. It is also the first report of using a stent or vascular reconstruction device rescue technique to secure an unstable Onyx cast and represents a new indication for these devices.

• Authors: Scott D Simon, Demetrius K Lopes, Robert A Mericle
• Journal: Neurosurgery (Neurosurgery) Vol. 66 Issue 3 Suppl Operative Pg. 92-7; discussion 97-8 (Mar 2010) ISSN: 1524-4040 [Electronic] United States
• PMID: 20173577 (Publication Type: Case Reports, Journal Article)

Chemical References

• Onyx HD 500
• Polymers
• Polyvinyls
• Dimethyl Sulfoxide

Topics

• Dimethyl Sulfoxide (adverse effects, therapeutic use)
• Embolization, Therapeutic (instrumentation, methods)
• Female
• Humans
• Intracranial Aneurysm (pathology, physiopathology, surgery)
• Middle Aged
• Polymers (adverse effects, therapeutic use)
• Polyvinyls (adverse effects, therapeutic use)
• Postoperative Complications (etiology, surgery)
• Reoperation
• Stents (standards)
• Treatment Outcome
• Vascular Surgical Procedures (instrumentation, methods)