Novel use of Onyx for treatment of intracranial vertebral artery dissection

This report describes a patient who presented with subarachnoid hemorrhage and extensive right posterior inferior cerebellar artery territory infarct secondary to a dissecting aneurysm of the right intracranial vertebral artery. Urgent endovascular treatment was undertaken with plans for trapping of the diseased segment with coils. However, significant intralesional stenosis limited distal microcatheter access. Therefore, using proximal flow arrest and adjunctive coiling, the liquid embolic agent Onyx was injected within the pseudoaneurysm and was able to traverse the stenosis, resulting in proximal and distal parent vessel closure. There were no embolic complications. During the 3 month hospital stay, there was no rebleeding. The patient was discharged to skilled nursing facility and was lost to follow-up.