Disrupted and migrated microcatheter in the vertebrobasilar artery system in endovascular embolization of cerebellar AVM: failure of endovascular and microneurosurgical retrieval

Abstract

Microcatheter disruption and migration is a rare etiology of complications that is directly attributable to preoperative embolization of arteriovenous malformations (AVMs). A 16-year-old male presented with cerebellar hemorrhage. Angiography showed an AVM in the right cerebellar hemisphere fed by the posterior inferior cerebellar artery (PICA) and superior cerebellar artery (SCA). During the procedures of preoperative embolization, a microcatheter was spontaneously disrupted before N-butyl-2-cyanoacrylate (NBCA) injection. The catheter migrated 13 cm into PICA, basilar artery (BA) and posterior cerebral artery (PCA). An attempt to retrieve the microcatheter by an endovascular procedure was not successful. Then, we attempted to pull out the microcatheter though an arteriotomy made in the PICA, after completion of AVM extirpation by suboccipital craniotomy. At the point of 6-cm retrieval the catheter was disrupted so that 7 cm of catheter was retained in PICA, BA and PCA. The patient returned to school with no neurological deficits. The long-term thromboembolic or toxic effects of migrated microcatheter into vertebrobasilar arterial system in this young patient should be carefully followed up.