Mechanical Removal of Migrated Onyx18 Due to Rupture of a Detachable-Tip Microcatheter During Arteriovenous Malformation Embolization

The rupture of a microcatheter leading to the spillage of ethylene vinyl alcohol copolymer (EVOH), specifically Onyx, though infrequent, can give rise to fatal complications. This case report elucidates the accidental migration of Onyx18 into the middle cerebral artery (MCA) and anterior cerebral artery (ACA) due to a ruptured microcatheter. The migration was successfully treated using an aspiration catheter and a Solitaire AB stent. Potential causes for microcatheter rupture include substandard microcatheter quality, prolonged injection intervals, inadequate Onyx mixing before injection, and extended syringe retention in a fixed position. Prompt identification and immediate embolus removal intervention are pivotal measures for curtailing severe complications.