Entrapment of microguidewire into perforator during endovascular treatment: Case report and management strategy

Despite advancements in endovascular equipment, life-threatening procedure-related complications, including arterial perforation, remain a concern. In particular, microguidewire entrapment in perforating arteries poses a significant risk of arterial avulsion injury. However, limited guidance exists on effectively managing such scenarios, and to the best of our knowledge, no cases of successful resolution of entrapment using nimodipine have been reported to date. A woman in her mid-60s with a history of anterior communicating artery aneurysm coil embolization presented with aneurysm regrowth. During stent-assisted coil embolization, a microguidewire was entrapped in the perforating artery. An additional microcatheter was inserted near the site of entrapment, and 2.3 mg of intra-arterial nimodipine was infused over 15 min while attempting retrieval with extreme caution. The entrapped microguidewire was successfully removed, and the planned stent-assisted coil embolization was completed without complications. Microguidewire entrapment in a perforating artery during endovascular treatment poses the risk of fatal avulsion injury. Gentle and cautious retrieval, supported by sufficient intra-arterial nimodipine administration, may provide a safer approach for managing such complications.