TY - JOUR T1 - How much safety is actually ‘safe’? Commentary on ‘Safety of the Apollo Onyx delivery microcatheter for embolization of brain arteriovenous malformations: results from a prospective post-market study’ by Meyers <em>et al</em> JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - e22 LP - e22 DO - 10.1136/neurintsurg-2021-018052 VL - 13 IS - 10 AU - Alexander Sirakov AU - Krasimir Minkin AU - Stanimir Sirakov Y1 - 2021/10/01 UR - http://jnis.bmj.com/content/13/10/e22.abstract N2 - We read with great interest the recently published article in the journal entitled ‘Safety of the Apollo Onyx delivery microcatheter for the embolization of brain arteriovenous malformations: results from a prospective post-market study’. This study yielded overall fantastic technical, angiographic results with low morbidity and mortality rates.1 The primary endpoints for which the trial was powered were clearly defined as follows: unintentional catheter tip detachment with clinical sequelae, catheter rupture/break/fracture with clinical sequelae, or retained catheter body in the vasculature. Secondary endpoints, both acute (30 days) and long term (12 months), are also presented and specified. Patients not experiencing an adverse event and without any catheter retained were considered successfully concluded. The study failed to document any cases of migration of the retained microcatheter tip after embolization. The authors identified that the device-related complications or adverse events were lower in their study than in previously published literature.The primary purpose of this commentary is to congratulate the authors for the well-conducted study and the results it yielded. However, we would like to use the opportunity to issue alarming attention to the JNIS readership over some worrying real-world and single-centre data regarding the safety of the Apollo microcatheter. Our institution is a perfect case example of a mid-volume cerebrovascular centre. For 8 years (January 2013 to January 2021) over 200 … ER -