Successful microsurgical extraction of a migrated coil in a pediatric patient after failed endovascular closure of a Blalock-Taussig shunt. Case report

Symptomatic Intracranial Artery Stenosis Due to an Unknown Embolus Following Cardiac Surgery: A Case Report

Intracranial artery occlusion due to a foreign body is a complication associated with cardiac surgery that is treated by various techniques. However, little is known about appropriate strategies for symptomatic intracranial artery stenosis due to an unknown embolic source. We reported a case of middle cerebral artery (MCA) stenosis after mitral valve repair (MVR) for infective endocarditis (IE). An 80-year-old man presented with right hemiplegia. MR angiography findings were normal, and diffusion-weighted imaging revealed subtle ischemic change in the left MCA territory. The patient was diagnosed with cardioembolic stroke owing to IE and performed MVR. Four days later, he suddenly presented with consciousness disorder and left hemiplegia. Computed tomography (CT) confirmed a very low-density area within the right MCA. MR angiography revealed right MCA stenosis, which corresponded to the low-density area on CT images. Diffusion-weighted imaging revealed new ischemic change in the right MCA territory. Angiography confirmed an irregular stenosis at the right M2 with antegrade blood flow, and the hemiplegia resolved during angiography. Conservative therapy was performed; however, the resting 123 I-IMP-single photon emission CT revealed moderate perfusion defect in the right MCA territory, and transient left hemiplegia appeared every few days. Therefore, 19 days after the initial transient ischemic attack, the patient was performed superficial temporal artery–MCA anastomosis, and the patient responded with a good clinical course without recurrence of the ischemic symptoms. This strategy may be a safe and effective treatment for symptomatic intracranial artery stenosis due to an unknown embolic source.

Fracture and Embolization of Distal Guide Catheter During Neuroendovascular Intervention

BACKGROUND

Embolic strokes mainly result from cardiac or vascular origins, but there are instances when they can arise from iatrogenic foreign bodies. Catheter coatings or retained microcatheters are mainly implicated in foreign body embolism following neuroendovascular intervention. However, there are no known descriptions for free-floating and/or dislodged microcatheter fragments in the literature.

CASE DESCRIPTION

We report the clinical details, imaging findings, and management of a 69-year-old woman who underwent elective pipeline embolization of an incidental right paraophthalmic artery aneurysm and suffered distal embolization of the radiopaque marker from a distal guide catheter (088 Neuron Max, Penumbra, Alameda, California, USA) used during neuroendovascular intervention. To the best of our knowledge, this is the first reported case of distal embolism from an unprovoked fracture of a neurointerventional catheter.

CONCLUSIONS

Knowledge of several salvage techniques is essential in preventing major cerebrovascular complications. It is imperative that a multilevel approach should be taken when treating foreign body embolism.