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Journal of Neuroradiology
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le vendredi 25 mai 2012
Doi : 10.1016/j.neurad.2012.03.010
Management of brain AVM procedural hemorrhagic complication by the “security” catheter technique
 

Daniel Giansante Abud ⁎ , Thiago Giansante Abud, Guilherme Seizem Nakiri
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 

Corresponding author. Tel.: +55 16 36 02 26 40; fax: +55 16 36 36 74 99.
Summary

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 2cm 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.


Keywords : Brain arteriovenous malformations, Endovascular treatment, Complications

Abbreviations : ACA, AVM, DSA, MCA, NBCA


OutlineMasquer le plan
Introduction
Technique
Discussion
Disclosure of interest


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Start of article
Introduction
Technique
Discussion
Disclosure of interest
References