docRonie Leo Piske, MD, PhD Hospital Beneficência Portuguesa de
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Ronie Leo Piske, MD, PhD Hospital Beneficência Portuguesa de
Onyx HD 500 in the treatment of 197 large necked intracranial aneurysm in 166 patients – long term results Ronie Leo Piske, MD, PhD São Paulo, Brasil Hospital BeneficênciaRLPiske Portuguesa de São Paulo, Brasil Disclosures I’m a proctor for Onyx aneurysms and BAVM for ev3 RLPiske São Paulo, Brasil The main concern about EVT of large necked intracranial aneurysms is the high rate of incomplete occlusion and recanalisation •Low packing density •Weak endotelization of the neck RLPiske São Paulo, Brasil Onyx HD 500 is introduced due its chemical and physical characteristics: •Fill almost 100% of the aneurysm •Reconstructive technique •Doesn’t suffer compaction •Stronger neo endotelization RLPiske São Paulo, Brasil 6 month control Neo endothelium RLPiske São Paulo, Brasil RLPiske São Paulo, Brasil 19 month RLPiske São Paulo, Brasil 50 months RLPiske São Paulo, Brasil Results in 197 aneurysms in 166 patients 27 patients with 2 aneurysms 2 patients with 3 aneurysms Lateral aneurysm 92% in ICA 151 female 15 male Post SAH Mass effect 35 24 familial Post embolization other 15 14 EVALUATION OF ONYX HD-500 EMBOLIC SYSTEM IN THE TREATMENT OF 84 WIDE- NECK INTRACRANIAL ANEURYSMS Piske, RL et al: Neurosurgery 64:E865–E875, 2009 RLPiske São Paulo, Brasil Results in 119 small (≤10mm) large necked aneurysms Immediate 119 (100%) 6 months n=87 18 months 36months n=44 n=19 •Complete - 101 (85%) 84 (96,5 %) 42 (95,5 %) 18 •Incomplete - 18(15%) 2(2,3 %) 2 (4,5 %) 1 •Recanalization 1 (1,2%) 0 7 have control from 44m to 85m - all with complete occlusion Results in 71 large aneurysms (>10 to 25mm) immediate 71 (100%) •Complete - 42 (59 %) •Incomplete - 29 (41 %) 6m n= 45 18 m n=26 36 m n=12 5-7 y n=8 34(75%) 20(80%) 9 7 3 1 8(18%) •Recanalization 2(4,5%) •Worsening 1(2,5%) 6 Recanalisation – partially thrombosed aneurysm 2 years RLPiske São Paulo, Brasil 6 months RLPiske São Paulo, Brasil RLPiske São Paulo, Brasil Stable incomplete occlusion “Stent” of Onyx 36 months after embo RLPiske São Paulo, Brasil Complications Definitive deficit -7 (3%) •Polygon 2 •Embolic 1 (OA) •Mass effect 2 •SAH – cause unknown 1 •Chorea – 1 Transient – 3 (1,5%) •Polygon 2 •Embolic 1 (stopped antiplatelet) Death – 4 (2%) •Onyx cast migration 1 •Ischemic – no antiplatelet •Anestesic complication •SAH – microguide wire dissection RLPiske São Paulo, Brasil Main concerns about Onyx •Leakage into the parent artery •Late thrombosis/stenosis of the parent artery •Mass effect RLPiske São Paulo, Brasil Leakage: •Benign when is a thick layer •Benign to reconstruct the artery wall •May induce to stenosis when is a thin layer RLPiske São Paulo, Brasil Late stenosis of the parent artery RLPiske São Paulo, Brasil Thin layer of onyx collapses and neo endotelization produce stenosis RLPiske São Paulo, Brasil RLPiske São Paulo, Brasil RLPiske São Paulo, Brasil RLPiske São Paulo, Brasil 6 month control RLPiske São Paulo, Brasil Late stenosis (2%) or thrombosis (1,5%) of the parent artery •Individual answer of neo endotelization •Stenosis is more often in small aneurysms •Due to collapse of a thin layer of leaked onyx •In large/giant an – low flow with good polygon All stenosis or thrombosis were asymptomatic RLPiske São Paulo, Brasil Conclusions: •High rate of total occlusion •Results are stable after 6 months •Low rate of recanalisation •Low rate of complications •Incomplete occlusion are stable and small RLPiske São Paulo, Brasil Future: •Very efficient for small aneurysms •Associate with flow diverter stent in large/giant •Improvements in the balloon RLPiske São Paulo, Brasil
