Over-the-catheter retrieval of a retained microcatheter following Onyx embolization: a technical report.

BACKGROUND: Brain arteriovenous malformations are vascular lesions that are increasingly being treated with endovascular embolization. A potential complication with endovascular embolization is microcatheter entrapment within the embolic material. In the present report, a novel technique for the retrieval of microcatheters retained during Onyx embolization of intracranial lesions is described. CLINICAL PRESENTATION: Two patients (one boy and one girl, aged 13 and 15 years, respectively) with arteriovenous malformations (one unruptured, one ruptured; Spetzler-Martin grades 4 and 3) presented for embolization. INTERVENTION: During Onyx 18 embolization of the arteriovenous malformations, Echelon-10 microcatheters became entrapped into the arterial feeders by casts of the Onyx. Initial attempts to remove the microcatheters by traction were unsuccessful. The hubs of the microcatheters were transected and Concentric Medical Outreach distal access catheters were then advanced over the microcatheters and positioned at the proximal aspects of the microcatheter-Onyx plugs. Using the Outreach catheters for countertraction, the Echelon-10 microcatheters were then successfully released from the Onyx plugs under fluoroscopic visualization without significant distortion of the arteries. There were no complications related to the microcatheter extractions. CONCLUSIONS: A novel technique, which may be useful in the removal of retained microcatheters during Onyx embolization of Brain arteriovenous malformations, is presented.

Variant carotid origin of left anterior inferior cerebellar artery mimicking infarct on angiography.

A case is presented of a rare anterior inferior cerebellar artery variant, originating from the internal carotid artery. This mimicked a cerebellar infarct on vertebral angiography of a patient who presented with dysmetria and gait imbalance. It is important for the neuroradiologist and neurointerventionist to be aware of common and unusual cerebellar arterial anatomic variants to avoid incorrect diagnoses, as well as understand possible implications for surgery and interventional therapies.

Rapid clot removal for acute stroke therapy: technical case report.

OBJECTIVE: Endovascular therapy for acute ischemic stroke offers hope to those patients who do not meet the strict inclusion criteria for intravenous tissue plasminogen activator. Because no approach or device can be optimal for every patient, it is desirable to have options. This case is the first report on a novel retrieval device which proved to be very effective in our patient. CLINICAL PRESENTATION: A 69-year-old woman with an acute ischemic stroke was excluded from treatment with intravenous tissue plasminogen activator because of an elevated international normalized ratio. INTERVENTION: We successfully treated this patient endovascularly using a device newly approved by the Food and Drug Administration. We achieved rapid recanalization and an excellent clinical outcome. CONCLUSION: Using a new retrieval device, we were able to rapidly and successfully treat an acute ischemic stroke in a patient not eligible for intravenous thrombolysis. This may offer another alternative in endovascular acute stroke therapy.