Rescue N-butyl-2 cyanoacrylate embolectomy using a Solitaire FR device after venous glue migration during arteriovenous malformation embolization: technical note

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One of the procedural risks in arteriovenous malformation (AVM) embolization is possible migration of the embolic agent into the venous drainage with an incomplete nidus occlusion, which may lead to severe hemorrhagic complications.

This report presents the case of a 29-year-old man who presented with a deep intraparenchymal hematoma on the left side secondary to the spontaneous rupture of a claustral AVM. Upon resorption of the hematoma, the patient underwent an initial therapeutic session of N-butyl-2 cyanoacrylate endovascular embolization, with the purpose of reducing the AVM volume and flow before performing Gamma Knife radiosurgery. After glue injection into one of the arterial feeders, the control angiography showed a partial migration of the glue cast into the straight sinus, with most of the nidus still visible. Because of the bleeding risk due to possible venous hypertension, it was decided to try to retrieve the glue from the vein by using a stent retriever via jugular access. This maneuver allowed a nearly complete removal of the glue cast, thereby restoring normal venous flow drainage. The patient showed no clinical worsening after the procedure.

To the authors’ knowledge, this is the first report of the use of the Solitaire FR device as a rescue glue retriever. This method should be considered by physicians in cases of unintended glue migration into the venous circulation during AVM embolization.

ABBREVIATIONSAVM = arteriovenous malformation; bAVM = brain AVM; DSA = digital subtraction angiography; NBCA = N-butyl-2 cyanoacrylate.
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Contributor Notes

Correspondence Federico Di Maria, Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris VI University, 47–83 Boulevard de l’Hôpital, Paris 75651, France. email: federico.dimaria@gmail.com.INCLUDE WHEN CITING Published online November 27, 2015; DOI: 10.3171/2015.5.JNS15145.Disclosures Dr. Sourour is a consultant for Covidien.

© AANS, except where prohibited by US copyright law.

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