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Transvenous Removal of Glue from Obstructed Straight Sinus during Transarterial Embolization
A Krajina1, M Lojik, J Nahlovsky
1Charles University Hospital, Hradec Kralove, Czech Republic.
Insights
Embolizing veins draining intracranial shunts can cause brain swelling and bleeding. Microsnare removal of glue from obstructed sinuses successfully treated this complication in two patients.
Area of Science:
- Neurosurgery
- Interventional Radiology
- Vascular Neurology
Background:
- Intracranial arteriovenous shunts are used to treat various neurological conditions.
- Complications can arise during embolization procedures, including inadvertent venous embolization.
- Venous embolization can lead to passive hyperemia, hemorrhage, and brain edema.
Purpose of the Study:
- To report a novel technique for managing inadvertent venous embolization during intracranial arteriovenous shunt embolization.
- To describe the successful removal of embolic material from the straight sinus using a microsnare device.
Main Methods:
- Case report of two patients experiencing inadvertent venous embolization during intracranial arteriovenous shunt embolization.
- Utilized a microsnare device for the removal of glue emboli from the straight sinus.
- Managed post-embolization hyperemia and edema with supportive care, including blood pressure management.
Main Results:
- Successful removal of glue emboli from the straight sinus in both cases.
- Resolution of passive hyperemia and associated symptoms.
- No major neurological deficits reported post-procedure.
Conclusions:
- Microsnare retrieval is an effective treatment for inadvertent glue embolization of draining veins from intracranial shunts.
- Prompt intervention can mitigate the risk of severe neurological sequelae such as hemorrhage and edema.
- This technique offers a viable option for managing a rare but serious complication in neurovascular procedures.
Summary:
Inadvertent embolization of the veins that drain arteriovenous intracranial shunts is likely to precipitate passive hyperemia with subsequent hemorrhage and brain edema. The mainstay of therapy for this complication is to decrease the flow through the shunt as much as possible and maintain the patient's blood pressure below baseline. We herein report our successful attempts at glue removal from partially obstructed straight sinus in two cases using a microsnare. This complication occurred during intracranial arteriovenous shunt embolization.
