Management of brain AVM procedural hemorrhagic complication by the "security" catheter technique.
Since the introduction of Onyx as a liquid embolic agent for the treatment of brain arteriovenous malformation (AVM), higher endovascular cure rates have been achieved. This may be partially attributed to its non-adhesive property, which allows longer intranidal progression of the embolic agent before solidification. However, Onyx reflux around the microcatheter can form a highly viscous plug, thereby constraining the microcatheter during its retrieval. Also, during the maneuver, arterial stretching can lead to vascular rupture and result in acute bleeding, a potentially fatal complication that demands immediate treatment. This report describes a new treatment strategy for the rapid management of such a complication. The technique consists of the placement of a second microcatheter about 2 cm proximal to the AVM nidus in the same artery containing the intranidal microcatheter. After conclusion of embolization, if rupture occurs during intranidal microcatheter retrieval, the second microcatheter that is already in place can promptly be used to control the bleeding.
Division of Interventional Neuroradiology, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Avenida Bandeirantes, 3900 Monte Alegre, Brazil. dgabud@fmrp.usp.br
Daniel Giansante
DG
Abud
Thiago Giansante
TG
Abud
Guilherme Seizem
GS
Nakiri
D002404:Catheterization / Q000379:methods*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control*; D002648:Child; D004121:Dimethyl Sulfoxide / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D006490:Hemostatics / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011145:Polyvinyls / Q000009:adverse effects* / Q000627:therapeutic use*; D011859:Radiography; D016896:Treatment Outcome
D006490:Hemostatics; C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide