Abstract Body: Background: Intracranial endovascular embolization is commonly performed to treat neurovascular arterial or venous diseases with various liquid embolic agents (LEAs) and techniques, some that polymerize in minutes, while others take substantially longer. Microcatheter retention is a feared complication with several case reports, but true rates being unknown. The aim of this study was to systematically compare microcatheter retention rates for different LEAs.
Methods: A systematic review of microcatheter retention for any neurovascular application was performed using PubMed and Europe PubMed Central on the Nested Knowledge platform for articles until October 2024. Studies were included if any LEA was used in any neurovascular disease, and reported on any microcatheter complications. The number of total patients and those (if any) in which the microcatheter was glued in or retained were extracted. Statistical analysis was performed to compare LEAs with at least 5 studies using a one-way ANOVA test for differences assuming unequal variances with the Games-Howell method.
Results: A total of 1433 articles were screened, of which 61 were included for analysis. Overall microcatheter retention was 5.0% (n=2,760 patients). Five LEAs were grouped in 6 categories: Cyanoacrylate (n=16 studies, 578 patients), Onyx (n=34 studies, 1497 patients), Onyx and/or cyanoacrylate (n=7 studies, 538 patients), PHIL (n=2 studies, 62 patients), SQUID (n=1 study, 30 patients), not specified (n=2 studies, 55 patients). Using categories with at least 5 studies, microcatheter retention rate using Onyx was 70% more than cyanoacrylate (nBCA) but not statistically significant (6.05% vs 3.56%, p=0.126). However, the studies in which either Onyx or nBCA were used had significantly lower microcatheter retention rates compared to Onyx alone (2.69% vs 6.05%, p=0.008).
Conclusions: Microcatheter retention is a complication encountered by Onyx or nBCA by approximately 1 in 20 patients, trending lower for nBCA vs Onyx, though non-significant.