Safety and efficacy using a detachable tip microcatheter in the embolization of pediatric arteriovenous malformations

David J. Altschul, Srinivasan Paramasivam, Santiago Ortega-Gutierrez, Johanna T. Fifi, Alejandro Berenstein

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Purpose: The treatment of deep-seeded pediatric brain arteriovenous malformations (AVMs) remains a challenging task. We describe our experience using a new detachable tip microcatheter in the embolization of brain arteriovenous malformations, pial arteriovenous fistulas, and vein of Galen malformations. We describe the safety and efficacy using a new detachable tip microcatheter in the treatment of pediatric deep brain arteriovenous malformations, pial malformations, and vein of Galen malformations. Methods: During a period of 9 months from March 2013 through January 2014, 11 pediatric patients in 14 procedures with 27 total injections were selected for treatment with a detachable tip under Food and Drug Administration (FDA) compassionate use exemption and were admitted to our department for treatment of their brain AVM using a liquid embolic agent and a detachable tip microcatheter. The ages of the patients ranged from 3 months to 18 years old. Results: Of the 27 total injections done, the tip detached in seven cases. For the 16 n-BCA injections, the tip detached six times (37.5 %), and for the 11 Onyx injections, the tip detached one time (9 %). There were no cases of premature microcatheter detachment during normal vessel navigation. Conclusions: The introduction of these detachable tip microcatheters allows for a safe and relaxed injection that permits a true circumferential occlusion, and may further permit filling a larger amount of angioarchitecture without the risk of distal migration, or vessel damage during the usual rapid removal of non detachable micocatheters.

Original languageEnglish (US)
Pages (from-to)1099-1107
Number of pages9
JournalChild's Nervous System
Volume30
Issue number6
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Arteriovenous Malformations
Pediatrics
Safety
Vein of Galen Malformations
Injections
Brain
Compassionate Use Trials
Cerebral Veins
Arteriovenous Fistula
United States Food and Drug Administration
Therapeutics

Keywords

  • Arteriovenous malformations
  • Detachable tip microcatheter
  • Embolization
  • n-BCA
  • Onyx
  • Pediatric
  • Pial arteriovenous fistula

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology
  • Medicine(all)

Cite this

Safety and efficacy using a detachable tip microcatheter in the embolization of pediatric arteriovenous malformations. / Altschul, David J.; Paramasivam, Srinivasan; Ortega-Gutierrez, Santiago; Fifi, Johanna T.; Berenstein, Alejandro.

In: Child's Nervous System, Vol. 30, No. 6, 2014, p. 1099-1107.

Research output: Contribution to journalArticle

Altschul, David J. ; Paramasivam, Srinivasan ; Ortega-Gutierrez, Santiago ; Fifi, Johanna T. ; Berenstein, Alejandro. / Safety and efficacy using a detachable tip microcatheter in the embolization of pediatric arteriovenous malformations. In: Child's Nervous System. 2014 ; Vol. 30, No. 6. pp. 1099-1107.
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abstract = "Purpose: The treatment of deep-seeded pediatric brain arteriovenous malformations (AVMs) remains a challenging task. We describe our experience using a new detachable tip microcatheter in the embolization of brain arteriovenous malformations, pial arteriovenous fistulas, and vein of Galen malformations. We describe the safety and efficacy using a new detachable tip microcatheter in the treatment of pediatric deep brain arteriovenous malformations, pial malformations, and vein of Galen malformations. Methods: During a period of 9 months from March 2013 through January 2014, 11 pediatric patients in 14 procedures with 27 total injections were selected for treatment with a detachable tip under Food and Drug Administration (FDA) compassionate use exemption and were admitted to our department for treatment of their brain AVM using a liquid embolic agent and a detachable tip microcatheter. The ages of the patients ranged from 3 months to 18 years old. Results: Of the 27 total injections done, the tip detached in seven cases. For the 16 n-BCA injections, the tip detached six times (37.5 {\%}), and for the 11 Onyx injections, the tip detached one time (9 {\%}). There were no cases of premature microcatheter detachment during normal vessel navigation. Conclusions: The introduction of these detachable tip microcatheters allows for a safe and relaxed injection that permits a true circumferential occlusion, and may further permit filling a larger amount of angioarchitecture without the risk of distal migration, or vessel damage during the usual rapid removal of non detachable micocatheters.",
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AU - Ortega-Gutierrez, Santiago

AU - Fifi, Johanna T.

AU - Berenstein, Alejandro

PY - 2014

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N2 - Purpose: The treatment of deep-seeded pediatric brain arteriovenous malformations (AVMs) remains a challenging task. We describe our experience using a new detachable tip microcatheter in the embolization of brain arteriovenous malformations, pial arteriovenous fistulas, and vein of Galen malformations. We describe the safety and efficacy using a new detachable tip microcatheter in the treatment of pediatric deep brain arteriovenous malformations, pial malformations, and vein of Galen malformations. Methods: During a period of 9 months from March 2013 through January 2014, 11 pediatric patients in 14 procedures with 27 total injections were selected for treatment with a detachable tip under Food and Drug Administration (FDA) compassionate use exemption and were admitted to our department for treatment of their brain AVM using a liquid embolic agent and a detachable tip microcatheter. The ages of the patients ranged from 3 months to 18 years old. Results: Of the 27 total injections done, the tip detached in seven cases. For the 16 n-BCA injections, the tip detached six times (37.5 %), and for the 11 Onyx injections, the tip detached one time (9 %). There were no cases of premature microcatheter detachment during normal vessel navigation. Conclusions: The introduction of these detachable tip microcatheters allows for a safe and relaxed injection that permits a true circumferential occlusion, and may further permit filling a larger amount of angioarchitecture without the risk of distal migration, or vessel damage during the usual rapid removal of non detachable micocatheters.

AB - Purpose: The treatment of deep-seeded pediatric brain arteriovenous malformations (AVMs) remains a challenging task. We describe our experience using a new detachable tip microcatheter in the embolization of brain arteriovenous malformations, pial arteriovenous fistulas, and vein of Galen malformations. We describe the safety and efficacy using a new detachable tip microcatheter in the treatment of pediatric deep brain arteriovenous malformations, pial malformations, and vein of Galen malformations. Methods: During a period of 9 months from March 2013 through January 2014, 11 pediatric patients in 14 procedures with 27 total injections were selected for treatment with a detachable tip under Food and Drug Administration (FDA) compassionate use exemption and were admitted to our department for treatment of their brain AVM using a liquid embolic agent and a detachable tip microcatheter. The ages of the patients ranged from 3 months to 18 years old. Results: Of the 27 total injections done, the tip detached in seven cases. For the 16 n-BCA injections, the tip detached six times (37.5 %), and for the 11 Onyx injections, the tip detached one time (9 %). There were no cases of premature microcatheter detachment during normal vessel navigation. Conclusions: The introduction of these detachable tip microcatheters allows for a safe and relaxed injection that permits a true circumferential occlusion, and may further permit filling a larger amount of angioarchitecture without the risk of distal migration, or vessel damage during the usual rapid removal of non detachable micocatheters.

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