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Neuroradiology

, Volume 48, Issue 2, pp 113–126 | Cite as

Late angiographic and clinical follow-up results of 100 consecutive aneurysms treated with Onyx reconstruction: largest single-center experience

  • H. Saruhan Cekirge
  • Isil SaatciEmail author
  • M. Halil Ozturk
  • Barbaros Cil
  • Anil Arat
  • Michel Mawad
  • Fikret Ergungor
  • Deniz Belen
  • Uygur Er
  • Sami Turk
  • Murat Bavbek
  • Zeki Sekerci
  • Ethem Beskonakli
  • Osman E. Ozcan
  • Tuncalp Ozgen
Interventional Neuroradiology

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.

Keywords

Intracranial aneurysm Onyx Long-term follow-up 

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • H. Saruhan Cekirge
    • 1
  • Isil Saatci
    • 1
    Email author
  • M. Halil Ozturk
    • 2
  • Barbaros Cil
    • 1
  • Anil Arat
    • 1
  • Michel Mawad
    • 3
  • Fikret Ergungor
    • 4
  • Deniz Belen
    • 5
  • Uygur Er
    • 5
  • Sami Turk
    • 5
  • Murat Bavbek
    • 4
  • Zeki Sekerci
    • 5
  • Ethem Beskonakli
    • 4
  • Osman E. Ozcan
    • 6
  • Tuncalp Ozgen
    • 6
  1. 1.Department of RadiologyHacettepe University HospitalAnkaraTurkey
  2. 2.Department of RadiologySSK Diskapi HospitalAnkaraTurkey
  3. 3.Department of RadiologyBaylor College of MedicineHoustonUSA
  4. 4.Department of NeurosurgeryNumune HospitalAnkaraTurkey
  5. 5.Department of NeurosurgerySSK Diskapi HospitalAnkaraTurkey
  6. 6.Department of NeurosurgeryHacettepe University HospitalAnkaraTurkey

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