Balloon-assisted technique for trapped microcatheter retrieval following onyx embolization. A case report

Abstract

During embolization of a large frontal arteriovenous malformation (AVM), Onyx-18 (eV3) was injected into an M3 branch of the middle cerebral artery via a Marathon microcatheter (eV3). After 40 minutes of embolization, the microcatheter could not be retracted due to fixation within the Onyx cast despite prolonged, robust attempts. A balloon microcatheter (Hyperform(TM), eV3) was advanced distally and inflated to provide distal counter tension, allowing microcatheter retrieval with minimal traction on the vasculature.

Figures

Figure 1

Lateral projection fluoroscopy demonstrates a Marathon microcatheter fixed into position by Onyx-18 embolization material within an M2 segment of the right middle cerebral artery (MCA). Robust attempts at retraction caused straightening of the M2 segment, without catheter retraction.

Figure 2

A balloon microcatheter was advanced into the same M2 branch containing the fixed microcatheter. The balloon was inflated, providing counter tension and allowing retraction and removal of the previously fixed microcatheter.