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Case Reports
. 2019 Jun;25(3):297-300.
doi: 10.1177/1591019918814011. Epub 2018 Nov 21.

Accidental guide catheter fracture in mechanical thrombectomy

Abdul Rahman Al-Schameri  1 , Aviraj Deshmukh  2 , Hadi Debaseh  3 , Christoph Griessenauer  2   4 , Monika Killer-Oberpfalzer  2
Affiliations
Case Reports

Accidental guide catheter fracture in mechanical thrombectomy

Abdul Rahman Al-Schameri et al. Interv Neuroradiol. 2019 Jun.

Abstract

Endovascular thrombectomy is now the standard of care for large vessel occlusion stroke. The aim is to achieve rapid and complete recanalisation while avoiding complications. Apart from the conventional complications of neurointerventional procedures, mechanical thrombectomy has its unique set of complications, inherent to the disease pathophysiology. We describe an unusual complication of catheter fracture and subsequent distal embolisation into the cerebral vasculature, which was noticed 24 hours after the procedure. Due to a lack of clinical consequences, we decided to manage it conservatively. The patient died within the following few days from respiratory complications unrelated to the stroke or the endovascular thrombectomy procedure. Consequently, we were able to retrieve the fractured segment and carry out histopathological analysis, which helped us to identify exactly its origin from the guide catheter. We believe that systematic reporting and database compilation of such device-related complications will aid in the design and development of neurointerventional devices in the future.

Keywords: Stroke; complications; mechanical thrombectomy.

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Figures

Figure 1.
Figure 1.
(a) and (b) Non-contrast computed tomography scan showing dense middle cerebral artery (MCA) sign without early signs of ischaemia; (c) digital subtraction angiography of left carotid artery anteroposterior view showing an occlusion of M1 MCA and A2 anterior cerebral artery (ACA) (red arrow); (d) M1 MCA recanalisation with occluded A2 ACA; (e) final angiogram with thrombolysis in cerebral infarction (TICI) 3 flow.
Figure 2.
Figure 2.
Postoperative, retrospective analysis and autopsy findings: (a) 24-hour control computed tomography (CT) scan yielded a foreign body signal at the middle cerebral artery (MCA) bifurcation; (b) CT angiogram foreign body signal with patent MCA; (c) lateral view with foreign body at the MCA bifurcation; (d) postmortem dissection showing a broken piece from the NeuroMax guide catheter at the MCA bifurcation; (e) fractured piece of the NeuroMax catheter shaft.
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References

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