Glued Catheters during Embolisation of Brain AVMs with Acrylic Glue

Abstract

We evaluated the frequency and the side effects associated with gluing a piece of microcatheter in the feeder during embolisation of brain AVMs with acrylic glue. A retrospective analysis of 233 brain AVMs embolised with acrylic glue over a 15 year period has shown that 29 microcatheters were glued into the feeder. This represents 936 superselective catheterizations of different feeders followed by injection of glue. There was no side effect in 27 cases. Eight cases were operated upon a few hours or days after the complication occurred. The piece of tubing was removed in six cases. The reason for early surgery was the fear of extensive thrombosis of a major trunk (MCA or BA) or taking advantage of the catheter being still free in the cerebral vessel. In one case of temporal AVM, a Magic 1.5F coiled up into the distal basilar and PCA. In one case of left parietotemporal AVM, surgery was done one month after having glued a piece of tubing into the left MCA without side effect. The patient became hemiplegic and aphasic two hours after surgery. The thrombosed left MCA was reopened with Urokinase. The patient recovered with minor residual aphasia. The risk of side effects increases with the use of the Magic 1.5F that coils up into the vessel more easily than the Magic 1.8F. Leaving a piece of Magic catheter in the feeder to a brain AVM usually has no side effect. When there is a risk of thrombosis of a major trunk (MCA, BA) or when surgical resection is indicated, surgery should be done as soon as possibile because it is usually possible and easy to retrieve the piece of tubing from the intracranial circulation. The frequency of this complication has decreased since we starded using more diluted acrylic glue.