Penumbra Occlusion Device for neurovascular vessel sacrifice: Feasibility and application

•Standard coiling for parent vessel sacrifice is lengthy and expensive due to large number of coils.•Parent vessel sacrifice with the combination of PODs and standard coils appear to be a feasible, safe, and effective alternative to the traditional vessel sacrifice techniques.•Combination of PODs and standard coils require less coils and achieve satisfactory occlusion with reducing procedural and fluoroscopy times. The purpose of this study is to describe the use of the Penumbra Occlusion Device (POD), which is a coil with an enhanced anchor segment, along with standard coils for carotid and vertebral artery sacrifice, and to assess its feasibility, safety, and efficacy. This is a retrospective chart review of patients with vessel sacrifices who were treated using POD. For the procedure, a balloon test occlusion was performed prior to permanent arterial sacrifice. Following this, a POD was deployed followed by subsequent angiography to confirm occlusion. Secondary PODs or standard coils were deployed as necessary. A total of 5 internal carotid arteries and 5 vertebral arteries were treated in 10 patients. The mean vessel diameter of the vessel sacrificed was 4 mm (range 2.9–7.7 mm). The total mean number of coils required for vessel sacrifice was 7 (range 3–17). The mean number of PODs used for vessel sacrifice was 2.4 (range, 1–6). The mean number of additional standard coils used was 4.1 (range, 0–13). 9/10 (90%) parent arteries were successfully occluded. One patient had slow flow distal to the occluded segment. One (10%) of the patients had a delayed ischemic event. There were no immediate periprocedural complications including coil migrations or vessel dissections. 6/10 patients had follow-up imaging and no patients developed recanalization during the follow-up period. Parent vessel sacrifice using a combination of PODs and standard coils appear to be a feasible, safe and effective alternative to the traditional vessel sacrifice techniques.