Retrieval of N-Butyl-2-Cyanoacrylate Glue Migrated to the Vertebral Artery Via Dangerous Anastomosis, Using the Stent-Retriever Aspiration Technique, During Dural Arteriovenous Fistula Embolization: A Case Report

Overview

Journal J Neuroendovasc Ther

Specialty Neurology

Date 2023 Jul 28

PMID 37502131

Authors

Masaru Kiyomoto

Eishi Sato

Taro Yanagawa

Yoichi Harada

Toru Hatayama

Takuji Kono

Affiliations

Soon will be listed here.

Abstract

Objective: We report a case of accidental N-butyl-2-cyanoacrylate (NBCA) glue migration into the vertebral artery (VA) via dangerous anastomosis during transarterial embolization (TAE) for transverse sinus (TS)-dural arteriovenous fistula (DAVF), which was rescued by mechanical retrieval using a stent retriever and aspiration devices.

Case Presentation: A 49-year-old right-handed female patient was admitted to our hospital with motor aphasia. MRI revealed congestion in the left temporal and occipital lobes, involving a small hemorrhage. DSA revealed a DAVF complicated by a sinus thrombus in the left TS. The DAVF was mostly fed by the left occipital artery (OA) and drained into the cortical veins of the temporal and occipital lobes through the patent part of the sinus. TAE was performed via the left OA with low-concentration NBCA. However, NBCA glue migrated into the left VA through a dangerous anastomosis, and a left VA angiogram revealed severe VA stenosis and floating NBCA glue. There was a fragile attachment of the NBCA glue to the arterial inner wall; therefore, we successfully retrieved the NBCA glue with a stent retriever and aspiration devices without complications. Finally, TAE was performed using another feeder, and the DAVF was completely obliterated.

Conclusion: TAE using NBCA is useful for the treatment of DAVF; however, it should be noted that there is a risk of migration via potential anastomotic routes. Low-concentration NBCA glue can be retrieved using these devices in limited cases.

References

Miyamoto N, Naito I, Shimizu T, Yoshimoto Y . Efficacy and limitations of transarterial acrylic glue embolization for intracranial dural arteriovenous fistulas. Neurol Med Chir (Tokyo). 2015; 55(2):163-72. PMC: 4533409. DOI: 10.2176/nmc.oa.2014-0223. View

Takeuchi Y, Morishita H, Sato Y, Hamaguchi S, Sakamoto N, Tokue H . Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition. Jpn J Radiol. 2014; 32(8):500-17. DOI: 10.1007/s11604-014-0328-7. View

Xu K, Yang X, Li C, Yu J . Current status of endovascular treatment for dural arteriovenous fistula of the transverse-sigmoid sinus: A literature review. Int J Med Sci. 2018; 15(14):1600-1610. PMC: 6299407. DOI: 10.7150/ijms.27683. View

Berguer R, Flynn L, Kline R, Caplan L . Surgical reconstruction of the extracranial vertebral artery: management and outcome. J Vasc Surg. 2000; 31(1 Pt 1):9-18. DOI: 10.1016/s0741-5214(00)70063-2. View

Ferro J, Coutinho J, Jansen O, Bendszus M, Dentali F, Kobayashi A . Dural Arteriovenous Fistulae After Cerebral Venous Thrombosis. Stroke. 2020; 51(11):3344-3347. DOI: 10.1161/STROKEAHA.120.031235. View

van Dijk J, terBrugge K, Willinsky R, Wallace M . Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux. Stroke. 2002; 33(5):1233-6. DOI: 10.1161/01.str.0000014772.02908.44. View

Fahed R, Clarencon F, Sourour N, Chauvet D, Le Jean L, Chiras J . Rescue N-butyl-2 cyanoacrylate embolectomy using a Solitaire FR device after venous glue migration during arteriovenous malformation embolization: technical note. J Neurosurg. 2015; 125(1):173-6. DOI: 10.3171/2015.5.JNS15145. View

Kung D, Abel T, Madhavan K, Dalyai R, Dlouhy B, Liu W . Treatment of endovascular coil and stent migration using the merci retriever: report of three cases. Case Rep Med. 2012; 2012:242101. PMC: 3362840. DOI: 10.1155/2012/242101. View

Ahmed R, Ide S, Kiyosue H, Tanoue S, Matsumoto S, Mori H . Retrieval of a migrated N-butyl-2 cyanoacrylate cast using a snare-kit system during dural AVF embolization: A case report. Interv Neuroradiol. 2018; 24(5):571-573. PMC: 6116127. DOI: 10.1177/1591019918775957. View

10.

Hiramatsu M, Sugiu K, Hishikawa T, Nishihiro S, Kidani N, Takahashi Y . Results of 1940 embolizations for dural arteriovenous fistulas: Japanese Registry of Neuroendovascular Therapy (JR-NET3). J Neurosurg. 2019; 133(1):166-173. DOI: 10.3171/2019.4.JNS183458. View

11.

Soderman M, Pavic L, Edner G, Holmin S, Andersson T . Natural history of dural arteriovenous shunts. Stroke. 2008; 39(6):1735-9. DOI: 10.1161/STROKEAHA.107.506485. View

12.

Hill H, Beecham Chick J, Hage A, Srinivasa R . N-butyl cyanoacrylate embolotherapy: techniques, complications, and management. Diagn Interv Radiol. 2018; 24(2):98-103. PMC: 5873510. DOI: 10.5152/dir.2018.17432. View

13.

Lv X, Jiang C, Zhang J, Li Y, Wu Z . Complications related to percutaneous transarterial embolization of intracranial dural arteriovenous fistulas in 40 patients. AJNR Am J Neuroradiol. 2009; 30(3):462-8. PMC: 7051438. DOI: 10.3174/ajnr.A1419. View

14.

Chauhan R, Prasad C, Siddiqui S, Srinivas D . Embolectomy by SOLUMBRA Technique for Nontarget Intracranial Glue Migration- Complication and Bailout after Percutaneous Embolization of Orbital Meningioma. Neurol India. 2022; 69(6):1767-1771. DOI: 10.4103/0028-3886.333513. View

15.

Coelho A, Lobo M, Nogueira C, Gouveia R, Campos J, Augusto R . Overview of evidence on risk factors and early management of acute carotid stent thrombosis during the last two decades. J Vasc Surg. 2019; 69(3):952-964. DOI: 10.1016/j.jvs.2018.09.053. View

16.

Senturk C . Mechanical Removal of Migrated Onyx Due to Microcatheter Rupture During AVM Embolization: A Technical Case Report. Cardiovasc Intervent Radiol. 2015; 38(6):1654-7. DOI: 10.1007/s00270-015-1095-2. View

17.

Geibprasert S, Pongpech S, Armstrong D, Krings T . Dangerous extracranial-intracranial anastomoses and supply to the cranial nerves: vessels the neurointerventionalist needs to know. AJNR Am J Neuroradiol. 2009; 30(8):1459-68. PMC: 7051597. DOI: 10.3174/ajnr.A1500. View

18.

Stayman A, Nogueira R, Gupta R . A systematic review of stenting and angioplasty of symptomatic extracranial vertebral artery stenosis. Stroke. 2011; 42(8):2212-6. DOI: 10.1161/STROKEAHA.110.611459. View

19.

Masahira N, Ohta T, Fukui N, Yanagawa T, Kondou Y, Morimoto M . A direct aspiration first pass technique for retrieval of a detached coil. BMJ Case Rep. 2015; 2015. PMC: 4654212. DOI: 10.1136/bcr-2015-012039. View

20.

Nishi H, Ishii A, Satow T, Iihara K, Sakai N . Parent Artery Occlusion for Unruptured Cerebral Aneurysms: Results of the Japanese Registry of Neuroendovascular Therapy 3. Neurol Med Chir (Tokyo). 2018; 59(1):1-9. PMC: 6350003. DOI: 10.2176/nmc.st.2018-0190. View