Solitaire X Retrieval of Refluxed Menox18 During Carotid-Cavernous Fistula Embolization: Case Report

Menox18 is a non-adhesive ethylene–vinyl alcohol (EVOH) copolymer embolic agent developed as an alternative to Onyx to treat intracranial vascular malformations. Published studies have demonstrated efficacy comparable to Onyx without reports of any major complications, except for a microcatheter rupture. Reflux of EVOH embolic material is a potentially devastating complication leading to distal embolization, vessel occlusion, and ischemic stroke. Successful retrieval of refluxed Onyx using mechanical thrombectomy devices has been reported in isolated cases. Nevertheless, management of refluxed Menox18 within a major intracranial artery has not been described. We report two cases of refluxed Menox18 within the internal carotid artery during transarterial embolization of direct carotid-cavernous fistulas, successfully extracted using a Solitaire X stent retriever.