Use of the Amplatzer Vascular Plug as an Anchoring Scaffold for Coil-mediated Parent Vessel Occlusion: Technical Case Report

Abstract

Parent vessel sacrifice is a useful treatment strategy for fusiform intracranial aneurysms. Originally performed using the detachable silicone balloon, endovascular arterial occlusion is currently achieved using coils, a process which can be limited by coil mass migration. We demonstrate the use of the Amplatzer vascular plug as a fixed anchor within the target parent vessel to facilitate coil-mediated occlusion, especially in vascular segments not encased by a bony canal. The technique was used successfully in two patients: a 90-year-old woman presenting with IIIrd and VIth cranial nerve palsy from a fusiform left cavernous internal carotid aneurysm and a 44-year-old man with distal thromboemboli from a fusiform dissecting-type right vertebral artery involving the origin of the posterior inferior cerebellar artery. Both patients were treated successfully with proximal parent vessel occlusion using coils after deployment of an Amplatzer vascular plug proximal to the target lesion. With the Amplatzer device acting as a fixed anchor in the parent vessel, coils were deployed proximally in a compact configuration. After deployment of the vascular plugs and coils, hermetic occlusion of the parent vessel was documented angiographically. The Amplatzer vascular plug can facilitate coil occlusion of large cervical vessels by acting as a focal coil and embolic material immobilizer, which can prevent coil mass migration and lead to improved packing density.