Retrieval of refluxed Onyx cast during a paediatric AVM embolisation

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.