title: Safety and efficacy using a detachable tip microcatheter in the embolization of pediatric arteriovenous malformations.
abstract: OBJECTIVE
  The treatment of deep-seeded pediatric brain arteriovenous malformations (AVMs) remains a challenging task. We describe our experience using a new detachable tip microcatheter in the embolization of brain arteriovenous malformations, pial arteriovenous fistulas, and vein of Galen malformations. We describe the safety and efficacy using a new detachable tip microcatheter in the treatment of pediatric deep brain arteriovenous malformations, pial malformations, and vein of Galen malformations.
  
  
  METHODS
  During a period of 9 months from March 2013 through January 2014, 11 pediatric patients in 14 procedures with 27 total injections were selected for treatment with a detachable tip under Food and Drug Administration (FDA) compassionate use exemption and were admitted to our department for treatment of their brain AVM using a liquid embolic agent and a detachable tip microcatheter. The ages of the patients ranged from 3 months to 18 years old.
  
  
  RESULTS
  Of the 27 total injections done, the tip detached in seven cases. For the 16 n-BCA injections, the tip detached six times (37.5 %), and for the 11 Onyx injections, the tip detached one time (9 %). There were no cases of premature microcatheter detachment during normal vessel navigation.
  
  
  CONCLUSIONS
  The introduction of these detachable tip microcatheters allows for a safe and relaxed injection that permits a true circumferential occlusion, and may further permit filling a larger amount of angioarchitecture without the risk of distal migration, or vessel damage during the usual rapid removal of non detachable micocatheters.
authors.affiliation: Center for Endovascular Surgery, Hyman-Newman Institute for Neurology and Neurosurgery, Suite 10G, Mount Sinai-Roosevelt Hospital, 1000 Tenth Ave., New York, NY, 10019, USA, david.altschul@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Altschul
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Paramasivam
authors.forename: Santiago
authors.initials: S
authors.lastname: Ortega-Gutierrez
authors.forename: Johanna T
authors.initials: JT
authors.lastname: Fifi
authors.forename: Alejandro
authors.initials: A
authors.lastname: Berenstein
mesh_terms: D000293:Adolescent; D001165:Arteriovenous Malformations / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003487:Cyanoacrylates / Q000008:administration & dosage; D004569:Electroencephalography; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D005071:Evoked Potentials / Q000502:physiology; D005260:Female; D006801:Humans; D007223:Infant; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D011145:Polyvinyls / Q000008:administration & dosage; D015898:Tomography Scanners, X-Ray Computed; D062666:Vascular Access Devices
chemical_list: D003487:Cyanoacrylates; D011145:Polyvinyls