The novel use of Onyx for the rapid treatment of a traumatic carotid injury

Abstract

Penetrating neck injury causing internal carotid artery (ICA) transection is nearly always fatal. The novel use of Onyx Liquid Embolic System (Onyx LES) for rapid hemostasis of a traumatic cervical ICA transection is reported. A patient with a gunshot wound to the face and neck underwent emergent catheter angiography which revealed contrast extravasation from the right cervical ICA consistent with traumatic transection. The ipsilateral cerebral hemisphere showed collateral blood supply from the posterior communicating artery, and ipsilateral external carotid artery anastomoses of the facial, ethmoidal and ophthalmic arteries. Rapid endovascular repair of the transected cervical ICA was performed using Onyx LES. Onyx34 was injected at a rapid rate of 1 ml/min into the right ICA. Injection was continued until cast formation completely occluded the proximal cervical ICA but preserved the external carotid artery. This method very rapidly controlled bleeding and should be considered in these cases.

Endovascular therapy for cerebrovascular injuries after head and neck trauma

“…53 Alternatively, onyx may be used in an emergent setting to achieve hemostasis. 54 Temporary balloon occlusion testing can be performed prior to vessel sacrifice. Another option is vessel reconstruction by stent angioplasty as is occasionally employed in carotid blowout due to malignancy (Table 3) (Figures 3 and 4).…”

“…(c) Vertebral artery angiogram oblique cranial view demonstrating collateral flow across the posterior communicating artery with filling of the anterior and middle cerebral arteries. Reproduced with permission from Gandhi et al54…”

Endovascular treatment of blunt injury of the extracranial internal carotid artery: the prospect and dilemma

“…Certainly, the BOT must be performed before considering this option [89]. For arterial occlusion, the embolic materials include detachable balloons, coils, and liquid embolic agents [90,91].…”

Reply to Letter: Onyx for Embolization of Life-Threatening Hemoptysis: A Promising but Luxury Embolic Agent!

“…Respecting the manufacturer's recommendations, particularly about the slow rate of injection should help avoiding this phenomenon. According to some authors [2], EVAC injection can be done more quickly when the dead space of the microcatheter filled with DMSO is completely flushed. However, this is not clearly recommended for standard use due to the risk of a too high DMSO blood concentration and increased risk of cardiac and respiratory complications.…”