The evolution of embolic agents necessitates the use of microcatheters compatible with dimethyl sulfoxide (DMSO), with detachable tip microcatheters (DTMs) emerging as a significant innovation aimed at reducing the risk of catheter entrapment in embolization procedures. This study aims to compare the efficacy, safety, and DMSO compatibility of DTMs with non-detachable tip microcatheters (Non-DTMs) in the context of embolization treatments for neurovascular diseases.

Following PRISMA guidelines, a systematic literature search was conducted across PubMed, Scopus, Embase, and Web of Science databases until February 25, 2024. Primary outcomes included technical success and microcatheter-related complications, with a meta-analysis performed using a random-effects model to calculate proportions and odds ratios (OR) with 95% confidence intervals (Cl).

Forty-five studies involving 2,185 patients and 3,758 catheters (995 DTMs and 2763 Non-DTMs) were analyzed. Our analysis revealed that DTMs were associated with comparable rates of technical success (98.3% vs. 97.6%, p=0.68), favorable outcomes (93.9% vs. 93.6%, p=0.89), and microcatheter-related complications compared to Non-DTMs. Specifically, DTMs showed a 0.0% rate of microcatheter entrapment and hemorrhagic complications. Intended detachment was achieved in 41.7% (95% CI = 27.02–57.98) of cases and premature detachment was rare (0.1%; 95%CI = 0.00–1.23). In the analysis of comparative studies, microcatheter-related complications did not defer between DTM and Non-DTM groups.

Our study demonstrates the safety and efficacy of DTMs in embolization treatments, emphasizing their compatibility with DMSO-based embolic agents and their potential to enhance patient outcomes in neurointerventional procedures. Future research should focus on well-designed, larger, prospective, comparative multi-center studies to strengthen the evidence base and further optimize the use of DTMs in endovascular interventions.