Onyx embolization with the Apollo detachable tip microcatheter: A single-center experience

Abstract

<jats:sec><jats:title>Purpose</jats:title><jats:p> The Apollo Onyx Delivery Microcatheter (Ev3, Irvine, CA) is a detachable-tip microcatheter that was developed to reduce the risk of microcatheter entrapment during ethylene-vinyl alcohol copolymer (Onyx) embolizations. We report our experience with the microcatheter in a variety of neurointerventional procedures. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> We retrospectively reviewed all Onyx embolizations performed in the head, neck, and spine using the Apollo Onyx Delivery Microcatheter from its introduction at our institution in July 2014 to August 2016. Information regarding patient diagnoses, procedural details, as well as clinical outcomes were obtained from the electronic medical record, procedure reports, and relevant angiographic imaging. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> A total of 58 arterial pedicle Onyx embolizations were performed in 37 patients. There were no cases of microcatheter entrapment, early/inadvertent tip detachment, or vessel injury upon removal of the device. There were two instances (3.5%) of leakage of Onyx from the microcatheter detachment site during embolization, which did not result in adverse sequelae. Clinical outcomes were excellent, with nearly all embolizations achieving the intended goal. In multivariate analysis, length of Onyx reflux along the microcatheter tip and utilization of a higher viscosity agent, Onyx 34, were significantly associated with tip detachment. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> The use of the Apollo Microcatheter is both safe and effective during neurointerventional embolizations using Onyx. Leakage of liquid embolic agent from the detachment site is an infrequent technical complication that may be encountered with the device. </jats:p></jats:sec>

Rupture of a detachable-tip microcatheter away from the detachment zone during Onyx 18 embolization of an arteriovenous malformation and management of the complication

“…Rupture of a detachable microcatheter is a dreaded complication but one would expect it to occur at the junction of the detachable tip. Only one series of AVM embolizations using a detachable tip microcatheter has reported this complication 3. They observed a leakage of Onyx with two Apollo microcatheters at the level of the detachment site (3.5% of all the Apollo used), which occurred after a long pause (>90 s) with an occlusion of the distal tip.…”

Case report: Onyx embolization of tentorial dural arteriovenous fistula via the meningohypophyseal trunk and medial tentorial artery of Bernasconi-Cassinari

“…In addition, the Echelon-10 microcatheter should not be removed too early; it can support coils when removing the Marathon microcatheter. In addition to the Marathon microcatheter, the Apollo detachable tip microcatheter (Medtronic, Irvine, CA, USA) was an alternative for case 1 ( 28 ). However, the detachable tip lengths of 15 and 30 mm were too long, and the detachment zone may be located in the ICA.…”

Economic analysis of n-butyl cyanoacrylate compared with ethylene vinyl alcohol copolymer liquid embolic embolization of brain arteriovenous malformations (bAVMs) from a US hospital perspective

“…Once EVOH has been injected using a detachable-tip microcatheter and embolization is complete, it is gently withdrawn until it either releases from the EVOH cast or until the tip detaches. 15…”

“…9 EVOH delivery may be complicated by reflux along the tip of the microcatheter that may lead to catheter retention or embolization of non-target vessels. 14,15 Detachable-tip microcatheters may be used with EVOH bAVM embolization to mitigate risks related to catheter retention. 15 Balloon microcatheters can be used with EVOH bAVM embolization to reduce EVOH reflux around the microcatheter and expedite procedures because a plug does not need to be formed.…”

“…14,15 Detachable-tip microcatheters may be used with EVOH bAVM embolization to mitigate risks related to catheter retention. 15 Balloon microcatheters can be used with EVOH bAVM embolization to reduce EVOH reflux around the microcatheter and expedite procedures because a plug does not need to be formed. 14 While n-BCA and EVOH have different mechanisms and procedural application, meaningful differences in bAVM presurgical devascularization efficacy have not been demonstrated.…”