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).
- Vascular Malformation
- Liquid Embolic Material
- Arteriovenous Malformation
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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.