Abstract WMP26: Endovascular Arterial Deconstruction with a Combination of Onyx and Coils: Technique, Feasibility, and Complications

Abstract

Object: Permanent vessel deconstruction has become routine for the management of aneurysms, pseudoaneurysms, tumors, and carotid blowouts. We describe a new technique for carotid and vertebral artery deconstruction using a combination of Onyx and coils, and assess its feasibility, safety, and efficacy. Methods: Between 2008 and 2012, a total of 41 patients underwent carotid or vertebral artery deconstruction with a combination of Onyx and coils in our institution. A few coils were initially deployed in the parent vessel under proximal flow arrest followed by Onyx embolization directly into the coil mass. 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 occlusion. The mean number of coils used was only 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). All were the result of delayed ischemic events after vessel deconstruction; none were related to the occlusion technique. No patient developed a recurrence during the follow-up period (mean, 14 months). Conclusions: Parent vessel occlusion with a combination of Onyx and coils is feasible, safe, and effective and results in significant savings in terms of cost, operative time, and fluoroscopy time. Importantly, no complications related to the technique itself were encountered in the series. This new technique should replace the traditional deconstruction technique with coils alone.