ronie leo piske , md, phd hospital beneficência portuguesa de são paulo, brasil

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