J Cerebrovasc Endovasc Neurosurg.  2016 Sep;18(3):208-214. 10.7461/jcen.2016.18.3.208.

Preliminary Experience with Vascular Plugs for Parent Artery Occlusion of the Carotid or Vertebral Arteries

• Lee W
• Shin YS
• Kim KH
• Kim YB
• Hong CK
• Chung J

• KMID: 2355643
• DOI: http://doi.org/10.7461/jcen.2016.18.3.208

Abstract

OBJECTIVE
The purpose of this study was to report the authors' preliminary experience using the Amplatzer Vascular Plug (AVP) (St. Jude Medical, Plymouth, MN, USA) for parent artery occlusion of the internal carotid artery (ICA) or vertebral artery (VA).
MATERIALS AND METHODS
Between September 2008 and December 2015, we performed 52 therapeutic parent artery occlusions (PAOs) by an endovascular technique. Among them, 10 patients underwent PAO of the carotid or vertebral arteries using AVPs. Clinical and radiographic data of these patients were retrospectively reviewed.
RESULTS
The devices were used for VA dissection that presented with subarachnoid hemorrhage (SAH) in five patients, traumatic arteriovenous fistula (AVF) in two patients, spontaneous AVF in one patient, recurrence of carotid-cavernous fistula (CCF) in one patient, and symptomatic unruptured giant ICA aneurysm in one patient. The devices were used in conjunction with detachable and/or pushable coils and in the extracranial segments of the ICA or VA. Complete occlusion of the parent artery was achieved in all patients. There was one intra-procedural rupture of the VA dissection during coiling prior to using the device.
CONCLUSION
Results from the current series suggest that the AVP might be used for therapeutic PAO in the extracranial segments of the ICA or VA.

Keyword

Amplatzer vascular plug; Carotid artery occlusion; Endovascular treatment; Parent artery occlusion; Vertebral artery occlusion

MeSH Terms

Aneurysm
Arteries*
Arteriovenous Fistula
Carotid Artery, Internal
Endovascular Procedures
Fistula
Humans
Parents*
Recurrence
Retrospective Studies
Rupture
Subarachnoid Hemorrhage
Vertebral Artery*

Figure

• 

  Fig. 1 (A) A 62-year-old female suffered from right side carotid-cavernous fistula (CCF) with complete steal and was treated by internal carotid artery (ICA) occlusion with coil embolization. (B) After right ICA occlusion, the collaterals from the anterior and posterior communicating artery supplied the right hemisphere. White circles indicate coils packed in the cavernous sinus and the right ICA. (C) Recanalization of the right ICA and the CCF occurred. (D) Retreatment by right ICA occlusion was performed with several additional coils and an Amplatzer Vascular Plug type 2.

• 

  Fig. 2 A 38-year-old female with neurofibromatosis type I suffered from a large pulsatile mass on the left side of her neck. (A) Digital subtraction cerebral angiography revealed a very high-flow AVF from the V2 segment of the left VA to the cervical venous plexus with a large pseudoaneurysm or venous pouch just distal to the fistula. (B) Short-segment trapping of the left VA was performed. Two AVPs (type 4; white circles) were deployed distal and proximal to the fistula with coiling between the AVPs. (C, D) Final left VA angiography (C) and right VA angiography (D) revealed complete occlusion of the fistula (white circles indicate the AVPs and white arrow indicates the occlusion of retrograde flow). AVF = arteriovenous fistula; VA = vertebral artery.

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