title: Detachable-Tip Microcatheters for Liquid Embolization of Brain Arteriovenous Malformations and Fistulas: A United States Single-Center Experience.
abstract: BACKGROUND
  The US Food and Drug Administration recently approved a detachable-tip microcatheter, the Apollo microcatheter (eV3, Inc, Irvine, California), to prevent catheter entrapment during embolization of brain arteriovenous malformations (AVMs) using liquid embolic systems.
  
  
  OBJECTIVE
  To report technical aspects and clinical results of cerebral embolizations with the Apollo microcatheter in 7 embolizations in 3 adult patients.
  
  
  METHODS
  A 62-year-old man presented with an AVM in the parieto-occipital region measuring 3.6 × 1.6 cm with major cortical feeders from the right middle cerebral artery (MCA) and minor contribution from the distal right anterior cerebral artery. Two pedicles originating from the MCA were embolized. A 48-year-old woman presented with a left frontal AVM measuring 3.3 × 1.8 cm with arterial feeders from the left MCA, left middle meningeal artery, and contralateral anterior cerebral artery. Three pedicles originating from the left MCA were embolized. A 76-year-old man presented with an arteriovenous fistula with multiple fistulous connections and feeders from both vertebral and occipital arteries and the left posterior cerebral artery draining into the left transverse, torcula, and left sigmoid sinus. Two major occipital artery feeders were embolized.
  
  
  RESULTS
  Seven Apollo microcatheters were used with the Onyx 18 liquid embolic system. The length of the detachable tip was 15 mm in 2 and 30 mm in 5 embolizations. The mean microcatheter in-position time within the pedicle was 20 minutes. Detachment of tip occurred in 3 instances. No limitations in accessing target arterial feeders and safe tip disengagement were noted despite prolonged injection times.
  
  
  CONCLUSIONS
  Our initial experience supports the feasibility, safety, and effectiveness of detachable-tip microcatheters in treating brain AVMs and arteriovenous fistulas.
authors.affiliation: *Zeenat Qureshi Stroke Institute and ‡Department of Neurosurgery, CentraCare Health, St. Cloud, Minnesota.
authors.forename: Nabeel A
authors.initials: NA
authors.lastname: Herial
authors.forename: Asif A
authors.initials: AA
authors.lastname: Khan
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Sherr
authors.forename: Mushtaq H
authors.initials: MH
authors.lastname: Qureshi
authors.forename: M Fareed K
authors.initials: MF
authors.lastname: Suri
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
mesh_terms: D000368:Aged; D001164:Arteriovenous Fistula / Q000628:therapy*; D057785:Catheters; D002536:Cerebral Arteries / Q000473:pathology; D004338:Drug Combinations; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005260:Female; D006261:Headache / Q000209:etiology / Q000628:therapy; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000628:therapy*; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology; D009778:Occipital Lobe / Q000473:pathology; D010291:Paresis / Q000209:etiology / Q000628:therapy; D010296:Parietal Lobe / Q000473:pathology; D011145:Polyvinyls; D013635:Tantalum; D016896:Treatment Outcome; D014481:United States
chemical_list: D004338:Drug Combinations; C558446:Onyx 18; D011145:Polyvinyls; D013635:Tantalum