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 In the MAUDE data, there were 77 reports of catheter entrapment with Onyx embolization; microcatheter was retracted by surgical excision in 15, endovascular snare or other retriever devices in 5, deliberately entrapped inside the vessel using stent in 1, and left without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.

"No turn back approach" to reduce treatment time for endovascular treatment of acute ischemic stroke.

BACKGROUND: A delay in endovascular treatment is less likely if acute ischemic stroke patients proceed from emergency department (ED) to computed tomographic (CT) scanner and directly to angiographic suite (no turn back approach). We determined the feasibility of the "no turn back approach" and its effect on treatment times and patient outcomes. METHODS: The primary outcomes were procedures performed with a time interval: (1) between ED arrival and microcatheter placement of less than 120 minutes and (2) between CT scan acquisition and microcatheter placement of less than 90 minutes. We determined the effect of the no turn back approach on favorable outcome at discharge. RESULTS: There was a significantly higher rate of CT scan acquisition and microcatheter placement time of less than 90 minutes in patients in whom no turn back approach was used (57.6% versus 31.6%, P = .0007). There was a significantly higher rate of ED arrival to microcatheter placement time of less than 120 minutes in patients in whom no turn back approach was used (31.8% versus 13.7%, P = .004). In the exploratory analysis, there was a trend toward higher rate of favorable outcomes (odds ratio 1.6, 95% confidence interval .9-2.8, P = .07) among those treated with no turn back approach after adjusting for age, admission National Institutes of Health Stroke Scale score strata, congestive heart failure, and diabetes mellitus. CONCLUSIONS: The no turn back approach appeared to be feasible and reduced the time interval between ED arrival and microcatheter placement in acute ischemic stroke patients undergoing endovascular treatment.