Endovascular treatment of experimental aneurysms by use of a combination of liquid embolic agents and protective devices.

BACKGROUND AND
PURPOSE: The use of liquid embolic agents for embolization of cerebral aneurysms has been reported in the neurosurgical literature. The most important limitation of this technique is the relatively poor control of migration of the liquid embolic agent into the parent artery. We performed an experimental aneurysm study using a liquid embolic agent and different protective devices to evaluate the safety and technical feasibility of this endovascular technique.
METHODS: Forty lateral aneurysms were surgically constructed on 20 common carotid arteries of swine. Onyx alone was used to obliterate eight aneurysms. Onyx was also used in combination with microcoils (n = 11), microstents (n = 6), balloons inflated proximally to the neck of the aneurysm (n = 6), and across the neck of the aneurysm (n = 7). One control aneurysm was embolized with Guglielmi detachable coils (GDCs) alone.
RESULTS: The use of a microballoon across the neck of the aneurysm, a microstent deployed across the neck of the aneurysm, or the deposit of GDCs into the aneurysm allowed faster and more complete filling of the aneurysm with Onyx. However, these protection devices did not totally preclude intractable migration of Onyx into the parent artery (migration rate, 9-33%).
CONCLUSION: Although complete occlusion of experimental aneurysms with Onyx is feasible using protective devices, migration of the liquid embolic agent into the parent artery or intracranially remains a difficult challenge. Further experimental studies need to be performed to master this technique and to select those aneurysms that can be safely treated in clinical practice.