[A case of cerebral arteriovenous malformation with accidental migration of a microcatheter during endovascular procedure].

This is a report of a case of cerebral arteriovenous malformation with accidental breakaway of a microcatheter during endovascular embolization. A 25-year-old female suddenly suffered severe headache. CT scan demonstrated intraventricular hemorrhage, and the angiogram revealed right parieto-occipital AVM. We performed endovascular embolization using a flow-directed microcatheter (1.5F BALT MAGIC catheter) 2 weeks after onset, and the microcatheter broke accidentally and a fragment of the soft tip migrated to the distal posterior cerebral artery during the procedure. Although we tried to retrieve the catheter using several retrieval devices, we failed. Two days after the procedure we undertook surgical treatment. The migrated catheter was recognized in a small feeding artery which was stretched tightly, so retrieval was very risky. Using hemoclips for trapping the part of the catheter which remained in the feeder, we were able to retrieve it by cutting the feeder. Flow-directed microcatheters are very usefull in endovascular procedures, but it is necessary to handle them carefully in accord with sufficient knowledge of their use and handling methods.