title: Carotid and vertebral artery sacrifice with a combination of Onyx and coils: technical note and case series.
abstract: BACKGROUND
  Permanent vessel sacrifice has become a routine for the management of aneurysms, pseudoaneurysms, tumors, and carotid blowouts. The purpose of this study is to describe a new technique for carotid and vertebral artery sacrifice using a combination of Onyx and coils and to assess its feasibility, safety, and efficacy.
  
  
  METHODS
  The technique consists of deploying a few coils in the parent vessel under proximal flow arrest followed by Onyx embolization directly into the coil mass. A total of 41 patients underwent carotid/vertebral artery sacrifice using this technique in our institution.
  
  
  RESULTS
  A total of 26 internal carotid arteries and 15 vertebral arteries were treated. In all but one patient, a balloon test occlusion was performed prior to permanent arterial sacrifice. The mean number of coils used was 6.8 (range, 2-19). The total volume of Onyx used was 1.3 ml on average (range, 0.2-5.2 ml). All 41 (100%) parent arteries were successfully occluded. No distal migration of Onyx or coils was noted. Periprocedural complications occurred in 14.6% (6/41) of cases causing permanent morbidity in 7.3% (3/41). No patient developed a recurrence during the follow-up period (mean, 14 months).
  
  
  CONCLUSIONS
  Parent vessel sacrifice with a combination of Onyx and coils appears to be feasible, safe, and effective and may be an alternative to the traditional deconstruction technique with coils alone. The risk of thromboembolism exists with this technique, but there were no instances of Onyx migration.
authors.affiliation: Department of Neurological Surgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.affiliation: Department of Neurological Surgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA.|Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.affiliation: Department of Neurological Surgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Stavropoula I
authors.initials: SI
authors.lastname: Tjoumakaris
authors.affiliation: Department of Neurological Surgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Pascal M
authors.initials: PM
authors.lastname: Jabbour
authors.affiliation: Department of Neurological Surgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.affiliation: Department of Neurosurgery, University of Iowa, Iowa City, IA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Hasan
authors.affiliation: Department of Neurological Surgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Rosenwasser
authors.affiliation: Department of Neurological Surgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA. aaron.dumont@jefferson.edu.|Division of Neurovascular & Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University, 901 Walnut Street, 3rd Floor, Philadelphia, PA, 19107, USA. aaron.dumont@jefferson.edu.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Dumont
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000379:methods; D005240:Feasibility Studies; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D061185:Mechanical Thrombolysis / Q000379:methods*; D008875:Middle Aged; D011145:Polyvinyls / Q000627:therapeutic use*; D011859:Radiography; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D020217:Vertebral Artery Dissection / Q000000981:diagnostic imaging / Q000628:therapy*; D055815:Young Adult
chemical_list: D006490:Hemostatics; C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide