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Introduction Onyx has reflux or migration rate of 15.8% to non-target intracranial arteries. Endovascular bail-out procedures for Onyx were scarcely published and their safety, efficacy, and complications are poorly explained.Aim of study The purpose of this systematic review is to assess the safety and efficacy of endovascular retrieval for reflux or migrated Onyx. Specifically, we will define the success rate of endovascular retrieval, determine the degree of recanalization, complications and clinical outcome.Method To carry out this systematic review we used the PRISMA guidelines. We included scientific articles described for endovascular retrieval of Onyx. Pubmed, Scopus and Web of Science were used as a main source of information. Narrative synthesis was chosen to summarize and explain the findings since studies have variable endovascular approach and reporting of outcome. Risk of bias was assessed by CARE and ROBINS-I guidelines.Abstract A343 Figure 1PRISMA diagram for systematic review including searches in databases, registers, and other sources. PRISMA (preferred reporting items for systematic reviews and meta-analysisResults 10 non-target intracranial arteries were occluded by Onyx cast where endovascular retrieval were done using different technique: stent retrieval, aspiration technique, and combined stent+aspiration. As a result, 80% had successful retrieval with mTICI of 2b-3 while 20% had mTICI of 0. Furthermore, 30% had infarction, 20% developed vasospasm, and 10% migrated to peripheral arteries. Only one patient worsened his neurological condition after failed retrieval. Our illustrative cases achieved mTICI of 3 and MRS of 1.Abstract A343 Figure 2Degree of arterial recanalization after different endovascular techniques in retrieval of migrated onyx with their complications in patients from the selected published studies. (mTICI: modified Thrombolysis in cerebral infarction)Conclusion Sequential immediate endovascular retrieval of Onyx cast is safe and effective to maintain the patency of non-target arteries. Stent retriever combined with aspiration technique had excellent retrieval with minimal vascular complications even up to medium-sized arteries.Conflict of Interest No