Occurrence and Management Strategies for Catheter Entrapment with Onyx Liquid Embolization.

In June 2012, Food and Drug Administration (FDA) issued a warning about the risk of catheter entrapment associated with Onyx embolization. We used our experience, literature review, and FDA Manufacturer and User Facility Device Experience (MAUDE) data review to identify five strategies to address catheter entrapment: 1/. Surgical resection of vessel at point of entrapment of catheter and retraction from exterior portion at the femoral region; 2/. Advancing and closing the loop of snare over the entrapped catheter followed by retraction; 3/. Advancing the distal access catheter over the entrapped catheter and retraction with forward movement of the distal access catheters; 4/. Inflation of balloon catheter coaxial to the entrapped catheter with subsequent retraction; and 5/. Intravascular retention and internalization of microcatheter. In the MAUDE data, there were 77 reports of catheter entrapment with Onyx embolization; microcatheter was retracted by surgical excision in 15, endovascular snare or other retriever devices in 5, deliberately entrapped inside the vessel using stent in 1, and left without intervention within intravascular compartment in 27 patients.

Prevalence of and Factors Associated with Dural Thickness in Patients with Mild Cognitive Impairment and Alzheimer's Disease.

BACKGROUND AND PURPOSE: We performed this study to evaluate the prevalence of and factors associated with dural thickening in patients with mild cognitive impairment and Alzheimer's disease. METHODS: Alzheimer's disease neuroimaging initiative participants with axial FLAIR sequence magnetic resonance imaging (MRI) images were analyzed. Dural thickness was defined by a linear strip of hyperintense tissue signal along the dura mater observed in at least two different images without evidence of leptomeningeal involvement. RESULTS: Dural thickening was seen in 83 (34%) of 242 persons analyzed (mean age [±SD] 74±7 years: 150 were men) with either mild cognitive impairment or Alzheimer's disease. The mini mental score was not different in persons with (26±0.3) and without (26±0.2) dural thickening (p = 0.6). The proportion of patients with moderate or severe cognitive impairment (defined by mini mental status score) was similar at baseline and at 12-month evaluations. The rates of annual progression according to Alzheimer's disease assessment scale (p = 0.06) and clinical dementia scale (p = 0.001) were higher in persons without dural thickening. The annual rate of volume loss in entorhinal cortex was higher among persons with dural thickening. CONCLUSIONS: We found relatively high prevalence of dural thickening in patients with mild cognitive impairment and Alzheimer's disease.