Use of intracranial stenting to secure unstable liquid embolic casts in wide-neck sidewall intracranial aneurysms.
BACKGROUND
Onyx HD 500 (eV3, Irvine, CA) is a high-viscosity liquid embolic agent that has recently been approved in the United States as a humanitarian use device for the treatment of wide-neck sidewall intracranial aneurysms. Preliminary evidence suggest that liquid embolic agents can provide improved angiographic results with a lower incidence of recanalization compared to coil embolization.


OBJECTIVE
To report unstable Onyx casts and how to deal with them.


METHODS
We report 4 cases of intracranial aneurysms treated with Onyx HD 500 in which, after the aneurysm was successfully obliterated, the Onyx cast was noted to have 1 of 2 types of embolic cast instability. In all 4 cases, an intracranial stent or vascular reconstruction device (VRD) was placed across the Onyx cast at the aneurysm orifice and the cast was stabilized.


CONCLUSIONS
This series is the first published description of Onyx HD 500 aneurysm cast instability. It is also the first report of using a stent or vascular reconstruction device rescue technique to secure an unstable Onyx cast and represents a new indication for these devices.
Simon
Scott D
SD
Department of Neurosurgery, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA.
Lopes
Demetrius K
DK
Mericle
Robert A
RA
D004121:Dimethyl Sulfoxide / Q000009:adverse effects* / Q000627:therapeutic use; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D011108:Polymers / Q000009:adverse effects / Q000627:therapeutic use; D011145:Polyvinyls / Q000009:adverse effects* / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D015607:Stents / Q000592:standards*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods
C505752:Onyx HD 500; D011108:Polymers; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide