Distal to proximal snaring of a fractured microcatheter during dural AVF embolization

Gil Zur; Ange Diouf; Areej Fageeh; Brian Drake; Marlise P Dos Santos; Howard Lesiuk; Robert Fahed

doi:10.1016/j.neurad.2023.08.009

Distal to proximal snaring of a fractured microcatheter during dural AVF embolization

J Neuroradiol. 2023 Nov;50(6):600. doi: 10.1016/j.neurad.2023.08.009. Epub 2023 Sep 10.

Authors

Gil Zur¹, Ange Diouf², Areej Fageeh³, Brian Drake³, Marlise P Dos Santos⁴, Howard Lesiuk³, Robert Fahed⁵

Affiliations

¹ Interventional Neuroradiology section, The Ottawa Hospital, Ottawa, ON, Canada. Electronic address: [email protected].
² Interventional Neuroradiology section, The Ottawa Hospital, Ottawa, ON, Canada.
³ Interventional Neuroradiology section, The Ottawa Hospital, Ottawa, ON, Canada; Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ontario, Canada.
⁴ Neuroscientist, Ottawa Hospital Research Institute, Ontario, Canada; Scientist, uOttawa Brain and Mind Research Institute, Ontario, Canada; Associate Professor of Radiology, University of Ottawa, Ontario, Canada; Interventional Neuroradiologist, The Ottawa Hospital, Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ontario, Canada; Diagnostic and Interventional Neuroradiologist, Section of Neuroradiology, Department of Radiology, Radiation Oncology and Medical Physics, The Ottawa Hospital, Ontario, Canada.
⁵ Interventional Neuroradiology section, The Ottawa Hospital, Ottawa, ON, Canada; Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ontario, Canada.

PMID: 37699501
DOI: 10.1016/j.neurad.2023.08.009

Abstract

Detachable-tip microcatheters are frequently used for endovascular embolization of arteriovenous shunts. Occasionally, the detachable tip can break during navigation resulting in the loss of the microcatheter tip in a vessel, which can lead to thrombo-embolic complications and also limit further navigation into the vessel to complete treatment. We present a case of dural AV-fistula embolization that was complicated by the accidental detachment and loss of the tip of a microcatheter during navigation to injection site. The proximal tip of the broken catheter was not visible and therefore we were unable to capture its proximal part with a Snare. Ultimately, we navigated a microcatheter distal to the broken segment and successfully snared the microcatheter fragment retrogradely. (Video 1).

Keywords: Bailout; Fistula; Snare.

Publication types

Case Reports
Letter

MeSH terms

Catheterization
Catheters / adverse effects
Embolization, Therapeutic* / adverse effects
Embolization, Therapeutic* / methods
Equipment Design
Humans
Microsurgery