title: Novel double catheter technique with detachable microcatheter for the treatment of arteriovenous malformations: A technical note.
abstract: BACKGROUND
  Onyx has improved the safety and efficacy of endovascular treatment in the management of cerebral arteriovenous malformations (AVMs). However, during injection inadvertent reflux around the delivery microcatheter into important normal arterial branches remains a major challenge.
  
  
  METHODS
  We describe a new double arterial catheterization technique using a detachable tip microcatheter in conjunction with a second microcatheter to form a proximal antireflux Onyx plug. This novel technique allows for increased amounts of Onyx to be steadily injected while avoiding dangerous backflow in the treatment of AVMs.
  
  
  RESULTS
  The patient tolerated the procedure well without changes in hemodynamics. Using the novel double catheter technique, a significant portion of the AVM was embolized and the patient had no complications postoperatively.
  
  
  CONCLUSIONS
  The novel double catheter technique with a detachable microcatheter is a safe and effective technique to increase the amount of Onyx embolization material into the AVM nidus.
authors.affiliation: Department of Neurosurgery, Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center, Bronx, New York, USA.
authors.forename: David
authors.initials: D
authors.lastname: Altschul
authors.affiliation: Department of Neurosurgery, Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center, Bronx, New York, USA.
authors.forename: Arundhati
authors.initials: A
authors.lastname: Biswas
authors.affiliation: Department of Neurosurgery, Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center, Bronx, New York, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Nakhla
authors.affiliation: Department of Neurosurgery, Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center, Bronx, New York, USA.
authors.forename: Murray
authors.initials: M
authors.lastname: Echt
authors.affiliation: Department of Neurosurgery, Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center, Bronx, New York, USA.
authors.forename: David
authors.initials: D
authors.lastname: Gordon
keywords: Cerebral arteriovenous malformations; Endovascular treatment; Onyx; embolization