The novel use of Onyx for the rapid treatment of a traumatic carotid injury
- Chirag D Gandhi1,2,
- Ahmed El-Gengahy1,2,
- Oriana Ellen Cornett-Thompson1,2,
- Jacqueline Kraus1,2,
- Charles Joseph Prestigiacomo1,2
- 1Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
- 2Department of Radiology, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
- Correspondence to Dr C D Gandhi, Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey, 90 Bergen St, DOC Bldg, Suite 8100, Newark, NJ 07103, USA;
Contributors CDG was the attending during the procedure and completed the revisions requested as well supervised the initial draft. AE, OEC-T and JK aided with the writing of the manuscript and formatting of the figures. CJP was important in proof reading the work and guiding the writing of the discussion.
- Received 7 March 2011
- Revised 30 June 2011
- Accepted 5 July 2011
- Published Online First 23 July 2011
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.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.