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Case Reports
. 2020 Feb 18;6(1):52-56.
doi: 10.4103/bc.bc_18_19. eCollection 2020 Jan-Mar.

Therapeutic occlusion of the vertebral artery using a new penumbra occlusion device system and ruby coils (penumbra): A technical note

Jay P Kinariwala  1 , Gary B Rajah  2 , Rahul Vaidya  3 , Sandra Narayanan  1   2
Affiliations
Case Reports

Therapeutic occlusion of the vertebral artery using a new penumbra occlusion device system and ruby coils (penumbra): A technical note

Jay P Kinariwala et al. Brain Circ. .

Abstract

There are several methods to achieve the therapeutic sacrifice of the vessel, coiling brings the most commonly used. Penumbra occlusion device (POD) system is a newer modality for therapeutic large vessel occlusion, and it is the Food and Drug Administration approved only for peripheral vessels. We report a case where therapeutic vertebral artery (VA) occlusion was achieved with the POD system and Ruby coils for the first time. A patient was diagnosed with a new malignant-appearing tumor of the cervical spine. A conventional angiogram showed multiple tiny arterial feeders from the VA beyond scope of coil/onyx embolization, so we performed a balloon occlusion test followed by therapeutic sacrifice of the VA. A successful VA occlusion was achieved with significant reduction in the tumor blush, followed by open resection of the tumor. The patient had favorable postoperative course and without any neurological symptoms attributed to the VA occlusion.

Keywords: Cervical tumor; coil embolization; penumbra; penumbra occlusion device; ruby coils; vertebral artery sacrifice.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Initial pretreatment images. (a and b) Magnetic resonance imaging cervical spine with contrast sagittal and axial sections, showing C4 vertebral body tumor with neural foraminal stenosis and cord compression at C3–C4 and C4–C5 levels. (c and d) Diagnostic angiogram showing left and right vertebral injection with C4 vertebral body tumor blush more from the left than the right
Figure 2
Figure 2
Treatment images. (a) Balloon test occlusion with the balloon inflated in the left vertebral artery. (b) Penumbra occlusion device coils deployed with the evidence of persistent distal contrast opacification. (c) Ruby coils deployed and complete occlusion of the left vertebral artery. (d) Right vertebral artery injection showing no perfusion deficit and left V4 segment cross filling
Figure 3
Figure 3
Postoperative images. (a and b) Anterior fusion plate and penumbra occlusion device coils in anteroposterior and lateral view
See this image and copyright information in PMC

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