Microcatheter entrapment retrieval from Onyx embolization in brain arteriovenous malformations: A technical note

Area of Science:

• Interventional Neuroradiology
• Neurovascular Interventions
• Medical Device Technology

Background:

• Microcatheter entrapment is a potential complication during Onyx embolization of brain arteriovenous malformations (BAVMs).
• Existing techniques for microcatheter retrieval can be challenging and may carry risks.

Purpose of the Study:

• To introduce and evaluate a novel "pull-push-pull" technique for retrieving entrapped microcatheters during Onyx BAVM embolization.
• To assess the safety and efficacy of this technique as a primary management strategy.

Main Methods:

• Analysis of 37 patients undergoing BAVM embolization with Onyx 18 or 34 using Marathon microcatheters.
• Application of the "pull-push-pull" technique when microcatheter retrieval difficulties were encountered.
• The technique involves controlled retraction, stretching the Onyx cast, repositioning the microcatheter, and then completing retraction.

Main Results:

• Microcatheter removal difficulties occurred in 3 out of 37 patients (8.1%).
• The "pull-push-pull" technique was successfully utilized in 2 of these patients.
• No neurological complications were observed in patients treated with this technique.

Conclusions:

• The "pull-push-pull" technique is a safe and effective method for retrieving entrapped microcatheters during Onyx BAVM embolization.
• This technique may enhance microcatheter retrieval by leveraging the cohesive properties of Onyx.
• It can be considered as an initial management option before resorting to more complex retrieval methods.