• Stavropoula I Tjoumakaris, Aaron S Dumont, L Fernando Gonzalez, Robert H Rosenwasser, and Pascal M Jabbour.
• Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
• World Neurosurg. 2013 May 1;79(5-6):798.E13-6.

ObjectiveTo report a novel technique for temporary and permanent vessel occlusion with a single microcatheter and investigate its efficacy in endovascular management of cerebral aneurysms and invasive head and neck tumors.MethodsA 58-year-old woman with a history of T3N0 squamous cell carcinoma of the tongue with extensive surgical resections and radiotherapy presented to the emergency department with further wound dehiscence and exposure of the left cervical internal carotid artery (ICA). Digital subtraction angiography (DSA) was performed with the patient under conscious sedation. An Ascent balloon, 4 mm × 15 mm, was prepared and introduced into the proximal ICA. While the patient was fully awake, temporary balloon occlusion (TBO) was performed for 30 minutes. The Ascent balloon was kept inflated. Through the inflated Ascent balloon, coil embolization of the proximal ICA was initiated. The interstices of the coils were filled with Onyx 18 and Onyx 34 liquid embolic agents (ev3 Neurovascular, Inc, Irvine, California, USA).ResultsThe Ascent balloon can be used as a temporary balloon device and as a coil or Onyx embolization device. As a result, fewer catheters, guidewires, and balloon inflations and deflations are required for the procedure, which is both cost-effective and time-efficient. The combination of initial coiling to create a framework for the deconstruction with a liquid embolic agent (Onyx) is a safe and efficient technique for vessel deconstruction. Flow arrest with proximal balloon occlusion minimizes the risks of distal thromboembolic events during embolization.ConclusionsThis novel technique for temporary and permanent vessel occlusion with a single microcatheter is both cost-effective and time-efficient.Copyright © 2013 Elsevier Inc. All rights reserved.

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