Late angiographic and clinical follow-up results of 100 consecutive aneurysms treated with Onyx reconstruction: largest single-center experience.
We present the long-term clinical and angiographic follow-up results of 100 consecutive intracranial aneurysms treated with Onyx liquid embolic system (MTI, Irvine, Calif.), either alone or combined with an adjunctive stent, in a single center. A total of 100 aneurysms in 94 patients were treated with endosaccular Onyx packing. Intracranial stenting was used adjunctively in 25 aneurysms including 19 during initial treatment and 6 during retreatment. All aneurysms except two were located in the internal carotid artery. Of the 100 aneurysms, 35 were giant or large/wide-necked, and 65 were small. Follow-up angiography was performed in all 91 surviving patients (96 aneurysms) at 3 and/or 6 months. Follow-up angiography was performed at 1, 2, 3, 4 and 5 years in 90, 41, 26, 6 and 2 patients, respectively. Overall, aneurysm recanalization was observed in 12 of 96 aneurysms with follow-up angiography (12.5%). All 12 were large or giant aneurysms, resulting in a 36% recanalization rate in the large and giant aneurysm group. One aneurysm out of 25 treated with the combination of a stent and Onyx showed recanalization. There was also no recanalization in the follow-up of small internal carotid artery aneurysms treated with balloon assistance only. At final follow-up, procedure- or device-related permanent neurological morbidity was present in eight patients (8.3%). There were two procedure-related and one disease-related (subarachnoid hemorrhage) deaths (mortality 3.2%). Delayed spontaneous asymptomatic occlusion of the parent vessel occurred in two patients, detected on routine follow-up. Onyx provides durable aneurysm occlusion with parent artery reconstruction resulting in perfectly stable 1-year to 5-year follow-up angiography both in small aneurysms treated with balloon assistance only (0% recanalization rate) and large or giant aneurysms treated with stent and Onyx combination (4% recanalization rate). Endosaccular Onyx packing with balloon assistance may not be adequate for stable long-term results in those with a large or giant aneurysm. However, the recanalization rate of 36% in these aneurysms is better than the reported results with other techniques, i.e., coils with or without adjunctive bare stents.
Cekirge
H Saruhan
HS
Department of Radiology, Hacettepe University Hospital, Sihhiye, 06100, Ankara, Turkey.
Saatci
Isil
I
Ozturk
M Halil
MH
Cil
Barbaros
B
Arat
Anil
A
Mawad
Michel
M
Ergungor
Fikret
F
Belen
Deniz
D
Er
Uygur
U
Turk
Sami
S
Bavbek
Murat
M
Sekerci
Zeki
Z
Beskonakli
Ethem
E
Ozcan
Osman E
OE
Ozgen
Tuncalp
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D021721:Balloon Occlusion / Q000379:methods; D002533:Cerebral Angiography; D002648:Child; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011145:Polyvinyls / Q000627:therapeutic use*; D016896:Treatment Outcome
C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide