PMC6744810_01
Coronary angiography with a catheter located in the coronary artery. The dotted circle shows the ruptured distal fragment of the catheter, before it detached.
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F1
During the study, a distal fragment of the catheter ruptured and migrated, lodging inside a branch of the right middle cerebral artery [Figures 1 and 2].
Skull radiography, anteroposterior view. The dotted white circle shows the catheter fragment lodged in the right middle cerebral artery.
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F2
During the study, a distal fragment of the catheter ruptured and migrated, lodging inside a branch of the right middle cerebral artery [Figures 1 and 2].
Right internal carotid artery angiography, left anterior oblique view. The dotted white circle shows a double-lumen balloon inflated within the fragment of the catheter, the latter lodged in a branch of the right middle cerebral artery.
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F3
Then, we tried to pass it with a double-lumen 6 mm per 7 mm balloon (Eclipse, Balt, Montmorency, France), but it was impossible to pass distal to the catheter fragment with the balloon, and when we inflated it, the fragment was displaced distally [Figures 3 and 4].
Skull radiography, right anterior oblique view. Note inside the white circle the balloon inflated displacing the fragment distally.
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F4
Then, we tried to pass it with a double-lumen 6 mm per 7 mm balloon (Eclipse, Balt, Montmorency, France), but it was impossible to pass distal to the catheter fragment with the balloon, and when we inflated it, the fragment was displaced distally [Figures 3 and 4].
(a) Skull radiography. Continued white arrow shows the inflated balloon half inside the catheter fragment and half distal to it. Dotted white arrow shows the catheter fragment. (b) Skull radiography. Dotted white circle shows the inflated balloon pushing the catheter fragment at M1 segment of cerebral media artery. (c) Facial bones radiography. Dotted white circle shows the catheter fragment near the tip of the guide catheter at cervical segment of carotid artery. (d) Chest radiography centered on the clavicle. Inside the dotted white circle, note the inflated balloon and catheter fragment at the level of the right common carotid's origin. White arrow shows the tip of the guide catheter at the level of the right brachiocephalic trunk.
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F5
Then, we retrieved the balloon, fragment, and guide catheter together, and all of them were extracted with the radial sheath [Figure 5].
Postprocedural computed tomography of the brain, showing a subarachnoid hemorrhage.
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F6
After the procedure, the patient reported a headache, after which computed tomography (CT) demonstrated a subarachnoid hemorrhage (SAH) [Figure 6].
Follow-up angiography with no evidence of vascular lesions or residual intravascular evidence of the retrieved catheter fragment.
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F7
Control angiography was performed, documenting complete extraction of the fragment and no vascular complications [Figure 7].
Follow-up computed tomography of the brain, without secular lesions.
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F8
After 1 week, the patient was discharged, asymptomatic, having no neurological deficits, and with no residual evidence of a SAH on CT [Figure 8].