title: Initial experiences with the Amplatzer Vascular Plug 4 for permanent occlusion of the internal carotid artery in the skull base in patients with head and neck tumors.
abstract: BACKGROUND
  As the first report in the literature, we present our initial experiences with the latest generation's Amplatzer Vascular Plug 4 (AVP4) as a device for permanent occlusion of the internal carotid artery in its course in the skull base.
  
  
  METHODS
  Permanent occlusion of the internal carotid artery in the skull base was performed in four patients after administration of an intravenous heparin bolus (three patients preoperatively to facilitate radical surgery of head and neck tumors, one patient with a palliative intent to reduce tumor arrosion bleeding risk).
  
  
  RESULTS
  In all patients, the deployment of the AVP4 in the artery's course in the skull base was feasible. In two patients, placement was possible in the cavernous segment of the internal carotid artery, and in the other two patients, more proximal in the artery's foramen lacerum and petrous segment, respectively. Occlusion was accomplished in one patient with one AVP4 (occlusion time 25 min), in two patients with two AVP4 (occlusion time 20 min in each case), and in one patient with one AVP4, three additional fibered coils and two Gelfoam pledgets (occlusion time more than 2 h). Complications did not occur in any of the four patients.
  
  
  CONCLUSIONS
  The AVP4 may be a promising device for permanent occlusion of the internal carotid artery, allowing in its latest generation, navigability as distal as the cavernous segment in some, but not in all cases. Difficulties may still occur in very tortuous vessel anatomy.
authors.affiliation: Department of Radiology, Neuroradiology, Medical Faculty, University Düsseldorf, D-40225, Düsseldorf, Germany. stephan.macht@med.uni-duesseldorf.de
authors.forename: Stephan
authors.initials: S
authors.lastname: Macht
authors.forename: Christian
authors.initials: C
authors.lastname: Mathys
authors.forename: Jörg
authors.initials: J
authors.lastname: Schipper
authors.forename: Bernd
authors.initials: B
authors.lastname: Turowski
mesh_terms: D000368:Aged; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055989:Septal Occluder Device; D019291:Skull Base / Q000098:blood supply* / Q000000981:diagnostic imaging; D016896:Treatment Outcome