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Published on: September 25, 2016
A case of microguidewire entrapment during mechanical thrombectomy for posterior cerebral artery occlusion
Kohei Ishikawa1, Naoki Kato1, Gota Nagayama1
1Department of Neurosurgery, Division of Hepatobiliary and Pancreas Surgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
Background:
As mechanical thrombectomy is commonly performed, preparation for various complications is necessary. However, few reports have described microguidewires (MGWs) becoming entrapped.
Case Description:
An 83-year-old man with a history of cancer in the pancreatic head developed a disturbance of consciousness and left hemiplegia. Mechanical thrombectomy was performed for occlusion of the right posterior cerebral artery. The occluded lesion was passed using an MGW with a straight tip. The MGW became impossible to move after advancing into the perforator distal to the occluding thrombus. The MGW was removed using a goose-neck snare under general anesthesia. A small amount of subarachnoid hemorrhage occurred after wire removal but did not affect the clinical course.
Conclusion:
MGW entrapment is a rare complication in neuroendovascular therapy, particularly in mechanical thrombectomy. Removal of an entrapped MGW is associated with a risk of hemorrhagic complications. If the thrombus is hard and a J-shaped wire cannot be passed, the risk of MGW entrapment is high.
Insights
Microguidewire (MGW) entrapment during mechanical thrombectomy is a rare but serious complication. Prompt removal is possible but carries a risk of hemorrhage, especially with hard thrombi.
Area of Science:
- Neuroendovascular therapy
- Interventional neurology
- Cerebrovascular disease management
Background:
- Mechanical thrombectomy is a standard treatment for acute ischemic stroke.
- Complications during mechanical thrombectomy require careful preparation and management.
- Microguidewire (MGW) entrapment is an infrequently reported complication.
Observation:
- A case of MGW entrapment during mechanical thrombectomy for right posterior cerebral artery occlusion is presented.
- The MGW became entrapped distally within a perforator artery after navigating the occluding thrombus.
- Successful retrieval of the entrapped MGW was achieved using a goose-neck snare under general anesthesia.
Findings:
- MGW entrapment is a rare complication in neuroendovascular procedures, particularly during mechanical thrombectomy.
- Removal of entrapped MGWs can lead to hemorrhagic complications, such as subarachnoid hemorrhage.
- The risk of MGW entrapment increases when dealing with hard thrombi and inability to use a J-shaped wire.
Implications:
- Awareness of MGW entrapment is crucial for neurointerventionalists performing mechanical thrombectomy.
- Techniques for safe MGW retrieval should be readily available to manage entrapment complications.
- Further research may be needed to develop preventative strategies or improved retrieval methods for MGW entrapment.
