Liquid embolization of brain arteriovenous malformation using novel detachable tip micro catheter: a technical report

Abstract

Background and importance—Liquid embolization using Onyx® of brain arteriovenous malformations (AVMs) is sometimes limited by micro catheter retention by Onyx® cast during the disengagement
process. Use of the new detachable tip micro catheter is presented in this report.
Clinical presentation—Two feeding arteries of a previously ruptured brain AVM in a 62-year-old man
were embolized by Onyx 18 prior to surgery using the new Apollo™ micro catheter with the detachable-tip
(30 mm) was utilized. The arterial feeders were accessed without difficulty by micro catheter, guided by
0.010" microwire. Onyx reflux around the distal end of the micro catheter was necessary for effective
embolization of arteriovenous fistulous components of brain AVM. The micro catheter was successfully
retracted after embolization in both feeding arteries, with distal end detachment seen in one but not the
other arterial embolization. No arterial thrombosis, vasospasm, dissection, or rupture was seen at respective
sites of disengagement.
Conclusion—Use of the new micro catheters with detachable-tip design allowed prolonged Onyx® injection times, safe micro catheter disengagement, without any limitations in accessing target arterial feeders.