title: Balloon-augmented carotid artery sacrifice with Onyx: a proof of concept study in a swine model.
abstract: BACKGROUND
  Carotid sacrifice remains a valuable tool in the treatment of select vascular lesions. Neurointerventionalists have relied on coil embolization as their primary means of carotid sacrifice, a procedure that can be lengthy and expensive with long fluoroscopy times. We investigated a novel technique for carotid sacrifice in a swine model using temporary balloon occlusion to achieve proximal flow arrest in the carotid artery while embolizing the vessel with a liquid embolic agent.
  
  
  METHODS
  A total of 10 common carotid artery sacrifices were performed in pigs under fluoroscopic guidance. Various balloons were employed to achieve near total proximal flow arrest to allow an Onyx cast to accumulate in the target vessel.
  
  
  RESULTS
  The technique for sacrifice was modified during the experiment with the final procedures yielding successful sacrifice using Onyx through a dimethylsulfoxide-tolerant catheter (Echelon 14) with the assistance of two fibered coils and a 5 mm × 30 mm Hyperglide balloon resulting in a 2.5 cm long cast.
  
  
  CONCLUSIONS
  Carotid artery sacrifice using commercially available non-adhesive liquid embolic agents is feasible with balloon assistance, allowing for reduced radiation and material costs. Coils may be beneficial in providing an anchor point for liquid embolic deposition, as well as reducing the volume of liquid embolysate required to achieve vessel occlusion.
authors: Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors: Alejandro M
authors: AM
authors: Spiotta
authors: Thinesh
authors: T
authors: Sivapatham
authors: Qingshan
authors: Q
authors: Teng
authors: Shaye I
authors: SI
authors: Moskowitz
authors: Ferdinand K
authors: FK
authors: Hui
mesh_terms: D000818:Animals; D021721:Balloon Occlusion / Q000295:instrumentation / Q000379:methods*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging*; D004121:Dimethyl Sulfoxide / Q000008:administration & dosage*; D011145:Polyvinyls / Q000008:administration & dosage*; D011859:Radiography; D013552:Swine
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide