Purpose Endovascular vessel occlusion may be necessary to treat a variety of neurovascular pathologies such as pseudo-aneurysms and giant aneurysms, iatrogenic and penetrating vascular injuries and direct arteriovenous fistulas of the carotid and vertebral arteries. Endovascular devices commonly used for such deconstructive approaches include detachable balloons, micro-coils, liquid embolic agents or the Amplatzer vascular plug. In the recent months, a new device has become available for arterial occlusion that may have unique applications in neurovascular disease. The Micro Vascular Plug (MVP, Reverse Medical, Irvine, CA) has been designed for vessel occlusion through targeted embolization. It consists of electrolytically detachable ovoid Nitinol exoskeleton. The proximal portion of the plug is partially covered with PTFE (polyetrafluoroethylene) to ensure prompt and complete cessation of blood flow. The device comes in two sizes (3 mm and 5 mm); is fully re-sheathable and can be deployed quickly and predictably through a 0.021 or 0.027-inch micro-catheter. In this series, we report the results from our initial experience with eight consecutive patients in whom the MVP was used to achieve endovascular occlusion of an artery in the head and neck.
Methods This study includes eight consecutive patients collected over a nine-month period. Approval for this study was obtained from the Institutional Review Board. These eight patient’s radiographic and electronic medical records were reviewed in a retrospective fashion. Specifically demographic information, clinical indication, site of arterial occlusion, size of MVP, time to vessel occlusion, clinical complications, use of other secondary embolic agents and clinical outcome were recorded. Follow-up information, when available is presented.
Results Eight patients were treated with the Micro Vascular Plug for the treatment of neurovascular disease. The indications for treatment included: post-traumatic head/neck bleeding (n = 3), carotid-cavernous fistula (1), Vertebral-vertebral fistula (1), giant fusiform vertebral aneurysm (1), stump-emboli after carotid dissection (1) and iatrogenic vertebral artery penetrating injury (1). One device was used in 5 patients, two in 2 patients and one patient with extensive vertebral-vertebral venous fistula required three plugs for effectively trapping the fistula from both ends. Vessel occlusion was obtained in less than 2 min in each case and there were no procedural complications. Four patients have undergone follow-up studies and no incidence of plug migration or recanalization was observed.
Conclusion To the best of our knowledge, this is the first series reporting on the use of Micro Vascular Plug in neurovascular disease. While MVP has many of the benefits provided by the Amplatzer plug, it can be delivered via a microcatheter. The device can be re-sheathed and repositioned as necessary and vessel occlusion is immediate. In our case series, we have been able to easily navigate into small vessels like the proximal spheno-palatine artery and even retrogradely across the vertebro-basilar junction. Use of this device may be associated with shorter procedural and fluoroscopic times and potentially cost savings when compared with the use of micro-coils for vessel occlusion. Our experience shows that MVP can have unique applications in the neurovascular realm and it complements the currently available occlusive devices.
Disclosures D. Gandhi: 1; C; NIH, Stryker, Microvention. 2; C; Covidien, Reverse Medical, Microvention. G. Jindal: 1; C; Stryker. R. Shivashankar: None. T. Miller: None. N. Beaty: None.