Cerebral Aneurysm Multicenter European Onyx (CAMEO) Trial: Results of a Prospective Observational Study in 20 European Centers
Andrew J. Molyneuxa,
Saruhan Cekirgeb,
Isil Saatcib and
Gyula Gálc
a Neurovascular Research Unit, Radcliffe Infirmary, Oxford, UK
b Hacettepe University, Ankara, Turkey
c Uppsala University, Uppsala, Sweden
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FIG 1. 60-year-old male patient who presented with headache and in whom a large unruptured internal carotid aneurysm was found. Pretreatment, treatment, and follow-up images are presented.
A, Large internal carotid aneurysm before treatment.
B, Seal test before treatment of the aneurysm with Onyx. Microcatheter and balloon are in place with gentle contrast material injection into the aneurysm
C, Angiographic result immediately after Onyx treatment.
D, Follow-up angiogram 6 months after treatment, showing complete occlusion and intervening soft thickened tissue between vessel lumen and Onyx cast in the aneurysm
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FIG 2. 28-year-old hemophiliac patient with severe headaches but no evidence of subarachnoid hemorrhage has a wide-neck basilar bifurcation aneurysm involving the proximal right postcerebral artery.
A, Large basilar bifurcation and proximal posterior cerebral aneurysms.
B, Seal test, showing highly compliant Equinox balloon inflated in the basilar tip and in the right posterior cerebral artery with the balloon protecting the aneurysm neck, which takes up most of the proximal P1-segment vessel.
C, Immediate posttreatment image, showing reconstruction of the posterior cerebral artery segment.
D, Three-month follow-up angiogram, showing occlusion of the proximal posterior cerebral artery and the aneurysm.
E, Three-month right carotid angiogram, showing posterior cerebral perfusion via the posterior communicating artery. (Images courtesy of Mike Nelson, Leeds.)
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FIG 3. 50-year-old male patient with leg weakness and a possible history of subarachnoid hemorrhage. This patient was found to have a vertebral basilar junction aneurysm compressing the medulla.
A, Pretreatment angiogram showing a large vertebrobasilar junction aneurysm treated on two occasions (treated with an INX stent at the second procedure after recurrence). Complete occlusion was noted at 6-month and 1-year follow-up after second procedure.
B, Angiogram obtained after second treatment at 3 months after early recurrence and after placement of an INX stent and re-treatment with Onyx.
C, Unsubtracted image obtained after second procedure, showing INX stent and second cast of Onyx in inferior recurrent aneurysm pocket.
D, Follow-up angiogram obtained 6 months after second treatment.
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FIG 4. 45-year-old patient presenting with a partial cranial nerve III palsy and headache. No anterior cerebral artery was present on the left side and the carotid only supplied the left middle cerebral territory.
A, Lateral arterial phase carotid angiogram obtained immediately before treatment.
B, Final angiography obtained after Onyx treatment balloon catheter still present in vessel.
C, Follow-up angiography 3 months after procedure. Patient developed a complete ophthalomoplegia immediately after the procedure, which had resolved entirely by 3 months when she was asymptomatic. Note extensive orbital collaterals filling middle cerebral territory. (Images courtesy of Peter Flynn and Steven Mckinstry, Royal Victoria Hospital, Belfast.)
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