Novel Use of Pipeline Stent Device After Inadvertent Microcatheter Rupture During Arteriovenous Fistula Embolization.

Abstract

Onyx, a liquid embolic agent, is the mainstay of embolization treatment of arteriovenous malformation or arteriovenous fistula. Microcatheter retention in an embolic cast is a well-known complication. Rupture of catheter with spillage of onyx is a rare phenomenon but can lead to potential occlusion of the parent vessel. We describe a case in which a patient with ruptured arteriovenous fistula experienced rupture of a microcatheter at the proximal part and spillage of onyx on embolization. A Pipeline embolization device (PED) was successfully deployed, and onyx was jailed between the catheter and vessel wall at the third segment of the vertebral artery (V3 segment). A balloon angioplasty helped to complete the opening of the stent. The procedure was uneventful, and the patient recovered well. Follow-up angiogram revealed patency of posterior circulation. The 6-month follow-up angiogram revealed a patent stent. Microcatheter rupture and spillage of onyx during embolization of arteriovenous malformation/arteriovenous fistula is a potential complication, and management should be individualized. The unique close cell design of the PED was successfully used to avoid a potentially life-threatening occlusion of the vertebrobasilar system. To the best of our knowledge, we report for the first time this novel use of PED.