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Onyx HD 500 in the treatment of 197 large necked intracranial aneurysm in 166 patients – long term results. Ronie Leo Piske , MD, PhD Hospital Beneficência Portuguesa de São Paulo, Brasil. Disclosures . I’m a proctor for Onyx aneurysms and BAVM for ev3. - PowerPoint PPT Presentation
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RLPiske São Paulo, Brasil
Ronie Leo Piske, MD, PhDHospital Beneficência Portuguesa de São Paulo, Brasil
Onyx HD 500 in the treatment of 197 large neckedintracranial aneurysm in 166 patients – long term results
RLPiske São Paulo, Brasil
Disclosures
I’m a proctor for Onyx aneurysmsand 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 chemicaland 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
151 female 15 male
Post SAH 35Mass effect 24familial 15Post embolization 14other
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
Lateral aneurysm92% in ICA
6 months n=87
18 monthsn=44
42 (95,5 %)
2 (4,5 %)
0
Immediate119 (100%)
•Complete - 101 (85%)
•Incomplete - 18(15%)
•Recanalization
84 (96,5 %)
2(2,3 %)
1 (1,2%)
36monthsn=19
18
1
7 have control from 44m to 85m - all with complete occlusion
Results in 119 small (≤10mm)large necked aneurysms
immediate71 (100%)
Results in 71 large aneurysms(>10 to 25mm)
6 mn= 45
•Complete - 42 (59 %)
•Incomplete - 29 (41 %)
•Recanalization
•Worsening
34(75%)
8(18%)
2(4,5%)
1(2,5%)
18 mn=26
20(80%)
6
36 mn=12
9
3
5-7 yn=8
7
1
RLPiske São Paulo, Brasil
Recanalisation – partially thrombosed aneurysm
2 years
RLPiske São Paulo, Brasil
6 months
RLPiske São Paulo, Brasil
RLPiske São Paulo, Brasil
36 months after embo“Stent” of Onyx
Stable incomplete occlusion
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