title: Microcatheter entrapment retrieval from Onyx embolization in brain arteriovenous malformations: A technical note.
abstract: OBJECTIVE
  Many techniques have been use for retrieval of an entrapped microcatheter during Onyx (eV3 Neurovascular) embolization of brain arteriovenous malformations (BAVMs). We report our technique that we term "pull-push-pull" that can be utilized as first management in retrieving the microcatheter.
  
  
  METHODS
  We analyzed a total of 37 patients that underwent BAVM embolization with either Onyx 18 or 34 at our institution. Standard embolization techniques were utilized with the use of Marathon (eV3 Neurovascular) microcatheter. When difficulty in retrieving the microcatheter arose, we used the "pull-push-pull" technique. The technique comprises the eV3 protocol of retraction. In addition, the microcatheter is stretched causing the Onyx cast to stretch in its inner core, creating a more thorough cohesive property amongst the Onyx mixture. Then the microcatheter is pushed back and to its point of embolization origin. Afterwards, retraction of the microcatheter is enabled as it can be easily dislodged from the cast. Multiple attempts can be repeated as needed.
  
  
  CONCLUSIONS
  We had three patients that had difficulty with removal of microcatheter (8.1%). Utilization of the "pull-push-pull" technique was used on two of those patients. No neurological complication was observed with our technique. We believe the cohesive property of Onyx solution helps in the retrieval of the catheter by our method and technique.
  
  
  CONCLUSIONS
  We believe the "pull-push-pull" can be utilized and be an additional technique before attempting other catheter retrieval techniques in Onyx BAVM embolization.
authors.affiliation: Mercer University School of Medicine, USA phatdvu@gmail.com.
authors.forename: Phat D
authors.initials: PD
authors.lastname: Vu
authors.affiliation: Medical Center of Georgia, USA.
authors.forename: Arthur A
authors.initials: AA
authors.lastname: Grigorian
mesh_terms: D020878:Device Removal; D004338:Drug Combinations; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000628:therapy*; D011145:Polyvinyls / Q000627:therapeutic use*; D013635:Tantalum / Q000627:therapeutic use*
chemical_list: D004338:Drug Combinations; C558446:Onyx 18; D011145:Polyvinyls; D013635:Tantalum
keywords: Onyx; complication; embolization; entrapment; microcatheter