Summary of 16 patients with complications after endovascular treatment
Patient No | Location | High flow | Cortical vein drainage | Adjunctive technique | Onyx Approach | Complications | Clinical Outcome | Anatomic outcome |
1 | SS | Yes | No | Arterial BAT | Arterial | Asymptomatic Onyx migration into the jugular vein | Cure | Complete |
2 | SSS | No | No | Venous BAT | Arterial | Asymptomatic Onyx migration into the SSS | Improved | Near-complete |
3 | TS | Yes | No | Venous BAT | Venous | Symptomatic Onyx migration into the lung resulting in pulmonary embolism; femoral artery thrombosis requiring surgical thrombectomy | Cure | Complete |
4 | TS | Yes | Yes | Arterial coiling | Arterial | Onyx refluxed into the cavernous ICA through the extracranial–intracranial anastomosis | Death; withdraw of care due to poor prognosis | Partial |
5 | Tentorium | Yes | Yes | Venous coiling | Arterial | New cranial nerve VI palsy | Improved | Complete |
6 | Clivus | Yes | Yes | Venous coiling | Arterial | New cranial nerve X and XI palsies; worse cranial nerve III palsy | Cure | Complete |
7 | Hypoglossal canal | Yes | No | Venous coiling | Venous | New cranial nerve XII palsy | Cure | Near complete |
8 | TS | Yes | Yes | Arterial coiling | Arterial | Microcatheter fracture and retention in the ECA | Cure | Complete |
9 | Multiple | Yes | Yes | Venous coiling | Venous | Microcatheter trap in the Onyx cast and retention | Death; withdraw of care due to poor prognosis | Partial |
10 | Torcular herophili | Yes | Yes | Venous coiling | Venous | Microcatheter trap in the Onyx cast and retention | Cure | Partial |
11 | TS | Yes | No | Venous coiling | Venous | Cerebellar hematoma treated by surgical evacuation | Improved | Complete |
12 | CS | No | Yes | Venous coiling | Venous | Thromboembolic occlusion in the MCA branch recanalized by intra-arterial thrombolysis | Cure | Complete |
13 | Sphenoidal region | Yes | No | Venous coiling | Venous | Asymptomatic stretched coil retention | Cure | Complete |
14 | Tentorium | Yes | Yes | No | Arterial | Microcatheter fracture and retention in the ECA | Cure | Complete |
15 | Multiple | Yes | Yes | No | Arterial | Microcatheter fracture in the ECA successfully retrieved using Merci device | Cure | Near complete |
16 | Torcular herophili | Yes | Yes | No | Arterial | Vessel dissection in the ECA during catheterization controlled with Onyx | Cure | Complete |
BAT, balloon assisted technique; CS, cavernous sinus.; ECA, external carotid artery; ICA, internal carotid artery; SS, sigmoid sinus; SSS, superior sagittal sinus; TS, transverse sigmoid sinus.