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Balloon-augmented carotid artery sacrifice with Onyx: a proof of concept study in a swine model
  1. Alejandro M Spiotta1,2,
  2. Thinesh Sivapatham2,
  3. Qingshan Teng2,
  4. Shaye I Moskowitz2,
  5. Ferdinand K Hui2
  1. 1Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Ferdinand K Hui, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, S80, Cleveland, OH 44195, USA; huif{at}


Introduction Carotid sacrifice remains a valuable tool in the treatment of select vascular lesions. Neurointerventionalists have relied on coil embolization as their primary means of carotid sacrifice, a procedure that can be lengthy and expensive with long fluoroscopy times. We investigated a novel technique for carotid sacrifice in a swine model using temporary balloon occlusion to achieve proximal flow arrest in the carotid artery while embolizing the vessel with a liquid embolic agent.

Methods A total of 10 common carotid artery sacrifices were performed in pigs under fluoroscopic guidance. Various balloons were employed to achieve near total proximal flow arrest to allow an Onyx cast to accumulate in the target vessel.

Results The technique for sacrifice was modified during the experiment with the final procedures yielding successful sacrifice using Onyx through a dimethylsulfoxide-tolerant catheter (Echelon 14) with the assistance of two fibered coils and a 5 mm×30 mm Hyperglide balloon resulting in a 2.5 cm long cast.

Conclusion Carotid artery sacrifice using commercially available non-adhesive liquid embolic agents is feasible with balloon assistance, allowing for reduced radiation and material costs. Coils may be beneficial in providing an anchor point for liquid embolic deposition, as well as reducing the volume of liquid embolysate required to achieve vessel occlusion.

  • Balloon
  • balloon assistance
  • carotid sacrifice
  • Onyx
  • vessel sacrifice

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  • Funding eV3 and Micrus provided material support for this study. We have no financial interest in the materials mentioned in this paper.

  • Competing interests None.

  • Ethics approval The study protocol received approval from the Cleveland Clinic Institutional Review Board and the Institutional Animal Care and Use Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.