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Neurology
Retrieval of refluxed Onyx cast during a paediatric AVM embolisation
  1. Kislay Kishore and
  2. Brian van Adel
  1. Neurosurgery and Neurointerventional Surgery, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Kislay Kishore; kishorek{at}mcmaster.ca

Abstract

Endovascular embolisation of arteriovenous malformations (AVM) has been greatly facilitated by liquid embolic agents. While advancements in catheter technology and techniques of creating a proximal plug minimise the risk of inadvertent proximal reflux of the embolysate, this remains one of the main complications associated with use of liquid embolics.

We report a case of paediatric AVM embolisation which was complicated by parent vessel occlusion due to inadvertent proximal reflux of the embolysate in pericallosal artery. This was safely and effectively rescued using a stent retriever manoeuvre, following similar principles and tenets as in endovascular thrombectomy in stroke. This is the first case report of using a newer smaller 3 mm stentriever in a paediatric medium vessel occlusion, although for a different aetiology but with the same goal.

Bail-out or rescue strategy as presented here is an important addition to neurointerventionalists’ armamentarium to salvage a non-targeted migration of liquid embolic agent.

  • Stroke
  • Interventional radiology
  • Neurosurgery

https://doi.org/10.1136/bcr-2023-258422

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    Footnotes

    • X @kislaykishore9

    • KK and BvA contributed equally.

    • Contributors Both authors have contributed equally to the manuscript. KK and BAVA were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content. KK and BAVA gave final approval of the manuscript.

    • 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.