Retrieving microcatheters from Onyx casts in a series of brain arteriovenous malformations: a technical report
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To date, the "monorail snare technique" for the retrieval of entombed microcatheter tips during OnyxTM (ev3, Irvine, CA) embolisation of brain arteriovenous malformations (BAVM) has not been described. We report our experiences and some technical aspects in using this technique for the retrieval of entombed MarathonTM microcatheter (ev3, Plymouth, MN) tips during Onyx embolisation of BAVM treatment.
Onyx was used in the embolisation of 11 patients using 25 feeders over 14 sessions. The ‘monorail snare technique’ was employed for 14 feeders. Each time, an Amplatz 4 mm Gooseneck MicrosnareTM (ev3, Plymouth, MN) was loaded into an Excelsior 1018TM microcatheter (Boston Scientific, Natick, MA). The Marathon microcatheter was cut just distal to the hub, and the Amplatz/Excelsior combination was introduced along the length of the Marathon microcatheter towards its distal end, as far as possible. The embedded catheter was ensnared and both catheters were pulled free.
Microcatheter tip removal was successful in all cases, except for one microcatheter tip becoming detached and needing no further intervention. There were no complications as a direct result of the snare technique.
The monorail snare technique is a safe and easy technique for retrieving Onyx-encased microcatheter tips in the treatment of BAVM.
KeywordsOnyx Brain arteriovenous malformation Monorail snare technique
- 1.Pierot L, Januel AC, Herbreteau D, Barreau X, Drouineau J, Berge J, Souror N, Cognard C (2009) Endovascular treatment of brain arteriovenous malformations using Onyx: results of a prospective, multicenter study. J Neuroradiol 36(3):147–152. doi:10.1016/j.neurad.2008.11.005 PubMedCrossRefGoogle Scholar
- 3.Kelly ME, Turner R, Gonugunta V, Rasmussen P, Woo HH, Fiorella D (2008) Monorail snare technique for the retrieval of an adherent microcatheter from an Onyx cast: technical case report. Neurosurgery 63(ONS Suppl 1):ONSE91. doi:10.1227/01.NEU.0000310697.90077.F8
- 4.Fiorella D, Albuquerque FC, Deshmukh VR, McDougall CG (2005) Monorail snare technique for the recovery of stretched platinum coils: technical case report. Neurosurgery (1 suppl):E210; discussion E210 doi:5710.1227/01.NEU.0000163685.23846.DD