• Vol. 38 No. 9, 763–768
  • 15 September 2009

Neuroapplication of Amplatzer Vascular Plug for Therapeutic Sacrifice of Major Craniocerebral Arteries: An Initial Clinical Experience

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ABSTRACT

Introduction: Clinical use of the Amplatzer vascular plug in the cardiopulmonary and peripheral vasculatures has been described extensively in the literature. We present our initial experience in adapting this device for therapeutic sacrifice of major craniocerebral arteries. Materials and Methods: Between July 2007 and November 2008, 8 patients (mean age 59.1 years; range 18 to 82 years) underwent therapeutic occlusion of major craniocerebral arteries using the device, for direct caroticocavernous fistula (1 patient), symptomatic unruptured giant cavernous internal carotid aneurysms (2 patients), and preoperative embolisation before surgical resections of skull base tumours that had encroached upon the internal carotid or vertebral artery (5 patients). The plugs were used alone or in conjunction with detachable platinum coils. The applications of the device, as well as the angiographic and clinical results of the procedures were evaluated. Results: Applications of the plugs were straightforward and successful in all cases, with hermetic occlusions of all target arteries. When used without additional coils, several plugs were deployed in tandem to achieve complete occlusion of the artery. No migration of the device was seen. No patient developed untoward neurological deficits following the procedures, and the 3- and/or 6-month follow-up showed stable results. Conclusion: The Amplatzer vascular plug could be a valuable addition to the neurointerventional armamentarium, particularly in therapeutic occlusion of major craniocerebral arteries. Rigidity of the delivery system limits its current use to vessels below the skull base. The potential risk of distal thromboembolism also requires further evaluation.


Therapeutic sacrifice of major craniocervical arteries is a common and well-established neurointerventional procedure in the treatment of fusiform giant cerebral aneurysms, direct caroticocavernous fistulae and the control of torrential head and neck haemorrhage from a variety of causes, including carotid artery blowout.1-6 The procedure is also indicated preoperatively in patients with advanced head and neck or skull base tumours, when surgery may potentially damage the carotid or vertebral arteries.7,8 Detachable balloons and coils have historically been the conventional embolic devices that are used for these purposes.

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