Enhanced, rapid occlusion of carotid and vertebral arteries using the AMPLATZER Vascular Plug II device: the Duke Cerebrovascular Center experience in 8 patients with 22 AMPLATZER Vascular Plug II devices.
OBJECTIVE
Therapeutic embolization of the common carotid artery (CCA), internal carotid artery (ICA), and vertebral artery (VA) is necessary in the treatment of a subset of chronic arteriovenous fistulas (AVFs), hemorrhages, highly vascularized neoplasms before resection, and giant aneurysms. There are currently no reports of the use of the AMPLATZER Vascular Plug II (AVP II) device to occlude the CCA, ICA, or VA. The objective of this article is to present the Duke Cerebrovascular Center experience using the AVP II device in neurointerventional applications.


METHODS
This case series is a retrospective review of all of the cases at Duke University Hospital in which an AVP II device was used in the CCA, ICA, or VA up to September 2012. The AVP II device was often used in conjunction with embolization coils or as multiple AVP II devices deployed in tandem.


RESULTS
During 2010-2012, 8 cases meeting criteria were performed. These included 2 chronic VA to internal jugular AVFs, 1 hemorrhagic CCA to internal jugular AVF secondary to invasive head and neck squamous cell carcinoma, 1 ICA hemorrhage secondary to invasive head and neck squamous cell carcinoma, 1 ICA hemorrhage secondary to trauma, 1 ruptured ICA aneurysm, 1 giant petrous ICA aneurysm, and 1 case of cervical vertebral sarcoma requiring preoperative VA embolization. Successful occlusion of the target vessel was achieved in all 8 cases. There was 1 major complication that consisted of a watershed distribution cerebral infarct; however, this was related to emergent occlusion of the ICA in the setting of intracranial hemorrhage and was not a problem intrinsic to the AVP II device.


CONCLUSIONS
The AVP II device is relatively large, self-expanding vascular occlusion device that safely allows enhanced, rapid take-down of the CCA, ICA, and VA with low risk of distal migration.
Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA.
Frank
F
Mihlon
Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA.
Abishek
A
Agrawal
Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA.
Shahid M
SM
Nimjee
Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA.
Andrew
A
Ferrell
Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
Ali R
AR
Zomorodi
Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA.
Tony P
TP
Smith
Department of Neurosurgery, Methodist Hospital System, Houston, Texas, USA. Electronic address: gbritz@TMHS.org.
Gavin W
GW
Britz
D000293:Adolescent; D000328:Adult; D000368:Aged; D001159:Arterio-Arterial Fistula / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D002340:Carotid Artery Diseases / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000601:surgery; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery; D007601:Jugular Veins / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery; D012189:Retrospective Studies; D020217:Vertebral Artery Dissection / Q000601:surgery*; D014948:Wounds, Gunshot / Q000601:surgery; D055815:Young Adult
AMPLATZER; AVF; Embolization; Fistula; Internal carotid artery; Vertebral artery