title: A novel endovascular technique for temporary balloon occlusion and permanent vessel deconstruction with a single microcatheter.
abstract: OBJECTIVE
  To report a novel technique for temporary and permanent vessel occlusion with a single microcatheter and investigate its efficacy in endovascular management of cerebral aneurysms and invasive head and neck tumors.
  
  
  METHODS
  A 58-year-old woman with a history of T3N0 squamous cell carcinoma of the tongue with extensive surgical resections and radiotherapy presented to the emergency department with further wound dehiscence and exposure of the left cervical internal carotid artery (ICA). Digital subtraction angiography (DSA) was performed with the patient under conscious sedation. An Ascent balloon, 4 mm × 15 mm, was prepared and introduced into the proximal ICA. While the patient was fully awake, temporary balloon occlusion (TBO) was performed for 30 minutes. The Ascent balloon was kept inflated. Through the inflated Ascent balloon, coil embolization of the proximal ICA was initiated. The interstices of the coils were filled with Onyx 18 and Onyx 34 liquid embolic agents (ev3 Neurovascular, Inc, Irvine, California, USA).
  
  
  RESULTS
  The Ascent balloon can be used as a temporary balloon device and as a coil or Onyx embolization device. As a result, fewer catheters, guidewires, and balloon inflations and deflations are required for the procedure, which is both cost-effective and time-efficient. The combination of initial coiling to create a framework for the deconstruction with a liquid embolic agent (Onyx) is a safe and efficient technique for vessel deconstruction. Flow arrest with proximal balloon occlusion minimizes the risks of distal thromboembolic events during embolization.
  
  
  CONCLUSIONS
  This novel technique for temporary and permanent vessel occlusion with a single microcatheter is both cost-effective and time-efficient.
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Stavropoula I
authors.initials: SI
authors.lastname: Tjoumakaris
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Dumont
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.forename: Robert H
authors.initials: RH
authors.lastname: Rosenwasser
authors.forename: Pascal M
authors.initials: PM
authors.lastname: Jabbour
mesh_terms: D015901:Angiography, Digital Subtraction; D021721:Balloon Occlusion / Q000295:instrumentation*; D002294:Carcinoma, Squamous Cell / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D013529:Surgical Wound Dehiscence / Q000000981:diagnostic imaging / Q000628:therapy*; D014062:Tongue Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery*