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Ronie Leo Piske , MD, PhD Hospital Beneficência Portuguesa de São Paulo, Brasil

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.

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Ronie Leo Piske , MD, PhD Hospital Beneficência Portuguesa de São Paulo, Brasil

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  1. 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 RLPiske São Paulo, Brasil

  2. Disclosures I’m a proctor for Onyx aneurysms and BAVM for ev3 RLPiske São Paulo, Brasil

  3. The main concern about EVT of large necked intracranial aneurysms is the high rate of incomplete occlusionand recanalisation • Low packing density • Weak endotelization of the neck RLPiske São Paulo, Brasil

  4. 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

  5. 6 month control Neo endothelium RLPiske São Paulo, Brasil

  6. RLPiske São Paulo, Brasil

  7. 19 month RLPiske São Paulo, Brasil

  8. 50 months RLPiske São Paulo, Brasil

  9. 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 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

  10. Results in 119 small (≤10mm) largeneckedaneurysms 6 months n=87 18 months n=44 36months n=19 Immediate 119 (100%) • Complete - 101 (85%) • Incomplete - 18(15%) • Recanalization • 84 (96,5 %) • 2(2,3 %) • 1 (1,2%) 42 (95,5 %) 18 1 2 (4,5 %) 0 7 have control from 44m to 85m - all with complete occlusion

  11. Results in 71 large aneurysms (>10 to 25mm) 18 m n=26 6 m n= 45 36 m n=12 immediate 71 (100%) 5-7 y n=8 9 7 34(75%) 8(18%) 2(4,5%) 1(2,5%) • Complete - 42 (59 %) • Incomplete - 29 (41 %) • Recanalization • Worsening 20(80%) 3 1 6

  12. Recanalisation – partially thrombosed aneurysm 2 years RLPiske São Paulo, Brasil

  13. 6 months RLPiske São Paulo, Brasil

  14. RLPiske São Paulo, Brasil

  15. Stable incomplete occlusion “Stent” of Onyx 36 months after embo RLPiske São Paulo, Brasil

  16. 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

  17. Main concerns about Onyx • Leakage into the parent artery • Late thrombosis/stenosis of the parent artery • Mass effect RLPiske São Paulo, Brasil

  18. 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

  19. Late stenosis of the parent artery RLPiske São Paulo, Brasil

  20. Thin layer of onyx collapses and neo endotelization produce stenosis RLPiske São Paulo, Brasil

  21. RLPiske São Paulo, Brasil

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  24. 6 month control RLPiske São Paulo, Brasil

  25. 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

  26. 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

  27. Future: • Very efficient for small aneurysms • Associate with flow diverter stent in large/giant • Improvements in the balloon RLPiske São Paulo, Brasil

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