Nohra Chalouhi1, Robert M Starke1,2, Stavropoula I Tjoumakaris1, Pascal M Jabbour1, L Fernando Gonzalez1, David Hasan3, Robert H Rosenwasser1, Aaron S Dumont4,5. 1. Department of Neurological Surgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA. 2. Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA. 3. Department of Neurosurgery, University of Iowa, Iowa City, IA, USA. 4. Department of Neurological Surgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA. aaron.dumont@jefferson.edu. 5. Division of Neurovascular & Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University, 901 Walnut Street, 3rd Floor, Philadelphia, PA, 19107, USA. aaron.dumont@jefferson.edu.
Abstract
INTRODUCTION: Permanent vessel sacrifice has become a routine for the management of aneurysms, pseudoaneurysms, tumors, and carotid blowouts. The purpose of this study is to describe a new technique for carotid and vertebral artery sacrifice using a combination of Onyx and coils and to assess its feasibility, safety, and efficacy. METHODS: The technique consists of deploying a few coils in the parent vessel under proximal flow arrest followed by Onyx embolization directly into the coil mass. A total of 41 patients underwent carotid/vertebral artery sacrifice using this technique in our institution. RESULTS: A total of 26 internal carotid arteries and 15 vertebral arteries were treated. In all but one patient, a balloon test occlusion was performed prior to permanent arterial sacrifice. The mean number of coils used was 6.8 (range, 2-19). The total volume of Onyx used was 1.3 ml on average (range, 0.2-5.2 ml). All 41 (100%) parent arteries were successfully occluded. No distal migration of Onyx or coils was noted. Periprocedural complications occurred in 14.6% (6/41) of cases causing permanent morbidity in 7.3% (3/41). No patient developed a recurrence during the follow-up period (mean, 14 months). CONCLUSION: Parent vessel sacrifice with a combination of Onyx and coils appears to be feasible, safe, and effective and may be an alternative to the traditional deconstruction technique with coils alone. The risk of thromboembolism exists with this technique, but there were no instances of Onyx migration.
INTRODUCTION: Permanent vessel sacrifice has become a routine for the management of aneurysms, pseudoaneurysms, tumors, and carotid blowouts. The purpose of this study is to describe a new technique for carotid and vertebral artery sacrifice using a combination of Onyx and coils and to assess its feasibility, safety, and efficacy. METHODS: The technique consists of deploying a few coils in the parent vessel under proximal flow arrest followed by Onyx embolization directly into the coil mass. A total of 41 patients underwent carotid/vertebral artery sacrifice using this technique in our institution. RESULTS: A total of 26 internal carotid arteries and 15 vertebral arteries were treated. In all but one patient, a balloon test occlusion was performed prior to permanent arterial sacrifice. The mean number of coils used was 6.8 (range, 2-19). The total volume of Onyx used was 1.3 ml on average (range, 0.2-5.2 ml). All 41 (100%) parent arteries were successfully occluded. No distal migration of Onyx or coils was noted. Periprocedural complications occurred in 14.6% (6/41) of cases causing permanent morbidity in 7.3% (3/41). No patient developed a recurrence during the follow-up period (mean, 14 months). CONCLUSION: Parent vessel sacrifice with a combination of Onyx and coils appears to be feasible, safe, and effective and may be an alternative to the traditional deconstruction technique with coils alone. The risk of thromboembolism exists with this technique, but there were no instances of Onyx migration.
Authors: Stavropoula I Tjoumakaris; Aaron S Dumont; L Fernando Gonzalez; Robert H Rosenwasser; Pascal M Jabbour Journal: World Neurosurg Date: 2012-01-25 Impact factor: 2.104
Authors: Benjamin Zussman; L Fernando Gonzalez; Aaron Dumont; Stavropoula Tjoumakaris; Robert Rosenwasser; David Hasan; David Cognetti; Rita Axelrod; Pascal Jabbour Journal: World Neurosurg Date: 2011-11-07 Impact factor: 2.104
Authors: Mario Zanaty; Nohra Chalouhi; Robert M Starke; Stavropoula Tjoumakaris; L Fernando Gonzalez; David Hasan; Robert Rosenwasser; Pascal Jabbour Journal: Biomed Res Int Date: 2013-12-09 Impact factor: 3.411
Authors: Eliza Anderson; Nohra Chalouhi; Aaron Dumont; Stavropoula Tjoumakaris; Mario Zanaty; Robert Rosenwasser; Robert M Starke; Pascal Jabbour Journal: ScientificWorldJournal Date: 2014-10-27