Use of the Outreach Distal Access Catheter for microcatheter stabilization during intracranial arteriovenous malformation embolization

Abstract

The Outreach DAC is an intermediate-sized catheter designed for use with the Merci clot retriever in acute stroke. We investigated its utility as an adjunctive device during AVM pedicle embolization. In the authors' opinion, the DAC provided additional guide-catheter and microcatheter support, improved selective angiographic visualization of AVM angioarchitecture, aided microcatheter removal from its embedded position in the AVM Onyx cast, and enhanced local microcatheter control and safety, compared with embolization with the guide and microcatheter alone.

Fig 1.

A 19-year-old man presented to the emergency department with a new-onset seizure. Initial noncontrast cranial CT scan revealed a 5-cm heterogeneous right frontal mass, suspicious for AVM (not shown). The patient received diphenylhydantoin (Dilantin) and was taken for DSA. Anteroposterior (A) and lateral (B) views of the 5 × 4 cm Spetzler-Martin grade 3 AVM demonstrate filling from the right middle cerebral artery.

Fig 2.

Macro- (A) and microangiographic (B) runs with the microcatheter and DAC in place. The DAC is within a distal M3 branch (arrows). Lateral DSA (C) and lateral radiograph (D). After embolization, on withdrawing the microcatheter, the DAC is seen advancing into an M4 branch (arrows) and serves as a fulcrum for removing the microcatheter. E, Once the microcatheter is freed from the AVM nidus after the application of careful traction, the DAC and microcatheter can be seen as they are dislodged and snap back into the original location.