Intertwining Coil and Catheter During Brain Arterial-Venous Malformation Embolization: A Case Report of a Rare Complication.

Cerebral arteriovenous malformations (AVMs) are rare vascular anomalies associated with a risk of devastating intracerebral hemorrhage. They are often diagnosed following the appearance of seizures, focal neurological signs, or bleeding. In such cases endovascular embolization, which aims to occlude the AVM nidus and reduce risk of hemorrhage, has become a crucial therapeutic approach. Herein, we describe the case of a 62-year-old patient with a history of bleeding caused by cerebral AVM. During urgent endovascular embolization of the patient's AVM, a combination of large-caliber platinum coils and Onyx™ liquid embolic agent was used to achieve hemostasis after catheterizing a primary feeder. However, when the catheter was being pulled back, the proximal part of the coil migrated and became entangled with the catheter, thus remaining partially in the AVM and partially elongated in the access vessel thereby impeding the catheter from being completely removed from the percutaneous access. Surgical access with repair of the axillary artery was necessary to remove the catheter trapped in the coil. The successful outcome of this case demonstrates the importance of early recognition, timely intervention, and multidisciplinary team collaboration in managing AVM complications during neurovascular procedures to optimize patient outcomes.