Abstract
We present the long-term clinical and angiographic follow-up results of 100 consecutive intracranial aneurysms treated with Onyx liquid embolic system (MTI, Irvine, Calif.), either alone or combined with an adjunctive stent, in a single center. A total of 100 aneurysms in 94 patients were treated with endosaccular Onyx packing. Intracranial stenting was used adjunctively in 25 aneurysms including 19 during initial treatment and 6 during retreatment. All aneurysms except two were located in the internal carotid artery. Of the 100 aneurysms, 35 were giant or large/wide-necked, and 65 were small. Follow-up angiography was performed in all 91 surviving patients (96 aneurysms) at 3 and/or 6 months. Follow-up angiography was performed at 1, 2, 3, 4 and 5 years in 90, 41, 26, 6 and 2 patients, respectively. Overall, aneurysm recanalization was observed in 12 of 96 aneurysms with follow-up angiography (12.5%). All 12 were large or giant aneurysms, resulting in a 36% recanalization rate in the large and giant aneurysm group. One aneurysm out of 25 treated with the combination of a stent and Onyx showed recanalization. There was also no recanalization in the follow-up of small internal carotid artery aneurysms treated with balloon assistance only. At final follow-up, procedure- or device-related permanent neurological morbidity was present in eight patients (8.3%). There were two procedure-related and one disease-related (subarachnoid hemorrhage) deaths (mortality 3.2%). Delayed spontaneous asymptomatic occlusion of the parent vessel occurred in two patients, detected on routine follow-up. Onyx provides durable aneurysm occlusion with parent artery reconstruction resulting in perfectly stable 1-year to 5-year follow-up angiography both in small aneurysms treated with balloon assistance only (0% recanalization rate) and large or giant aneurysms treated with stent and Onyx combination (4% recanalization rate). Endosaccular Onyx packing with balloon assistance may not be adequate for stable long-term results in those with a large or giant aneurysm. However, the recanalization rate of 36% in these aneurysms is better than the reported results with other techniques, i.e., coils with or without adjunctive bare stents.
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Mawad ME, Klucznik RP, Ciceri EF, Cekirge S, Moret J (2001) Endovascular treatment of cerebral aneurysms with the liquid polymer Onyx: initial clinical experience. Presented at the 39th Annual Meeting of the American Society of Neuroradiology, Boston, 23–27 April, p 290
Murayama Y, Vinuela F, Tateshima S, Vinuela F Jr, Akiba Y (2000) Endovascular treatment of experimental aneurysms by use of a combination of liquid embolic agents and protective devices. AJNR Am J Neuroradiol 21(9):1726–1735
Mawad ME, Cekirge S, Ciceri E, Saatci I (2002) Endovascular treatment of giant and large intracranial aneurysms by using a combination of stent placement and liquid polymer injection. J Neurosurg 96(3):474–482
Molyneux AJ, Cekirge S, Saatci I, Gal G (2004) Onyx liquid embolic system in the treatment of cerebral aneurysms: results of a prospective observational study in 20 European centers: CAMEO Study. AJNR Am J Neuroradiol 25:39–51
Pamuk AG, Saatci I, Cekirge HS, Aypar U (2005) A contribution to the controversy over dimethyl sulfoxide toxicity: anesthesia monitoring results in patients treated with Onyx embolization for intracranial aneurysms. Neuroradiology 47:380–386
Molyneux A, Kerr R, Stratton I, et al (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1267–1274
International Study of Unruptured Intracranial Aneurysms (ISUIA) Investigators (1998) Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. N Engl J Med 339:1725–1733
International Study of Unruptured Intracranial Aneurysms (ISUIA) Investigators (2003) Unruptured intracranial aneurysms: natural history, clinical outcome and risks of surgical and endovascular treatment. Lancet 362 (9378):103–110
Sluzewski M, Menovsky T, van Rooij WJ, Wijnada D (2003) Coiling of very large and giant aneurysm: long-term clinical and serial angiographic results. AJNR Am J Neuroradiol. 24:257–262
Gruber A, Killer M, Bavinzski G, Richling B (1999) Clinical and angiographic results of endosaccular coiling treatment of giant and very large intracranial aneurysms: a 7-year, single-center experience. Neurosurgery 45(4):793–803
Murayama Y, Nien YL, Duckwiler G, et al (2003) Gugliemi detachable coil embolization of cerebral aneurysms: 11 years experience. J Neurosurg 98:959–966
Lylyk P, Cohen JE, Ceratto R, Ferrario A, Miranda C (2002) Endovascular reconstruction of intracranial arteries by stent placement and combined techniques. J Neurosurg 97:1306–1313
Han PP, Albuquerque FC, Maccay CI, et al (2003) Percutaneous intracranial stent placement for aneurysms. J Neurosurg 99(1):23–30
Benitez RP, Silva MT, Klem J, Veznedaroglu E, Rosenwasser RH (2004) Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils. Neurosurgery 54(6):1359–1368
Fiorella D, Albuquerque FC, Han P, McDougall CG (2004) Preliminary experience using the Neuroform stent for the treatment of cerebral aneurysms. Neurosurgery 54(1):6–17
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Cekirge, H.S., Saatci, I., Ozturk, M.H. et al. Late angiographic and clinical follow-up results of 100 consecutive aneurysms treated with Onyx reconstruction: largest single-center experience. Neuroradiology 48, 113–126 (2006). https://doi.org/10.1007/s00234-005-0007-6
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DOI: https://doi.org/10.1007/s00234-005-0007-6