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Onyx cast thrombectomy: bailout during thalamic AVM embolization
  1. Marco Colasurdo1,2,
  2. Huanwen Chen3,4,
  3. Gautam Edhayan5,
  4. Hashem Shaltoni6,
  5. Peter Kan7
  1. 1Neuroradiology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
  2. 2Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon, USA
  3. 3National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
  4. 4Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
  5. 5Department of Radiology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
  6. 6Department of Neurology, University of Texas Medical Branch, Galveston, Texas, USA
  7. 7Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
  1. Correspondence to Dr Peter Kan, Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA; ptkan{at}utmb.edu

Abstract

Microsurgical resection, radiosurgery, and endovascular embolization are the three different treatment approaches to cerebral arteriovenous malformations (AVMs). Although microsurgical resection remains the most desirable curative option and radiosurgery is often first choice in deep located/eloquent unruptured AVMs, transarterial or transvenous embolization may be pursued for ruptured AVMs not amenable to surgical resection. Most complications during endovascular treatment are related to hemorrhage; however, liquid embolic fragment migration or parent vessel occlusion are also possible and can lead to ischemic events. We present a case of endovascular Onyx (Medtronic, Minnesota, USA) embolization of a ruptured thalamic AVM complicated by Onyx reflux into the proximal posterior cerebral artery causing complete vascular occlusion. We demonstrate a bailout technique1–4 using combined stent-retriever and aspiration catheter to dislodge and retrieve the refluxed Onyx cast while maintaining total occlusion of the initially targeted arterial AVM feeder (video 1).

Video 1 ­

  • Vascular Malformation
  • Liquid Embolic Material
  • Arteriovenous Malformation
  • Technique
  • Thrombectomy

http://dx.doi.org/10.1136/jnis-2023-020832

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    Footnotes

    • Twitter @PeterKa80460001

    • Contributors MC, PK: acquisition of the data. MC, HC: drafting of the work and illustrations. MC, PK, GE, HS, HC: critical revision of the work and final approval of the version to be published. PK: conception and supervision of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests PK is on the Editorial Board of JNIS.

    • Provenance and peer review Not commissioned; externally peer reviewed.