Inadvertent Central Arterial Catheterization: An Unusual Cause of Ischemic Stroke

Abstract

Central venous catheter (CVC) insertion is extensively utilized in Intensive Care Units for evaluation of hemodynamic status, administration of intravenous drugs, and for providing nutritional support in critically ill patients. Unfortunately, CVC use is associated with complications including lung injury, bleeding, infection, and thrombosis. We present a patient with an acute ischemic stroke from an inadvertently placed CVC into the right common carotid artery. A 57-year-old male presented to our institution for left hemiplegia and seizures 2 days after a CVC was placed. He was found to have a right frontal ischemic stroke on computed tomography (CT). CT angiography noted that the catheter was arterial and had a thrombosis around it. He was started on a low-dose heparin infusion. A combination of cardiothoracic surgery and interventional cardiology was required to safely remove the catheter. Central arterial catheterization is an unusual cause for acute ischemic stroke and presents management challenges.

Accidental central venous catheter cannulation into aberrant arterial anatomy requiring endovascular intervention

“… 13 , 14 The lack of a true innominate artery led to an uncompromised carotid artery and was likely protective from stroke risk associated from CVC misplacement. Multiple case reports of patients developing strokes from accidental cannulation of the carotid arteries with CVCs exist, 15 , 16 with common etiology noted of direct damage to the arterial intima, leading to thrombus formation, with cerebral embolization. The ability to stent graft without coverage of the vertebral takeoff also was also protective from stroke risk in her case, though her contralateral vertebral was also patent.…”

Use of a Closure Device for the Management of Inadvertent Placement of a Central Venous Catheter in the Carotid Artery: A Case Report and Literature Review

“…Furthermore, adverse events are related to the male gender, and the number of punctures per attempt, when more than two punctures can lead to up to 54% of failure or mechanical complication [15]. Interestingly regarding the insertion site, there is some evidence that there are more arterial punctures (3.0% vs 0.5%) but less catheter malpositions (5.3% vs 9.3%) in the internal jugular compared with the subclavian access [16].…”

Pitfalls in internal jugular vein cannulation

“…Prolonged arterial catheterization can lead to thrombus formation with chances of stroke and risk of neurological deficits. Katyal et al [ 10 ] (2018) reported a case of acute ischemic stroke from an inadvertently placed CVC into the right common carotid artery. Another rare complication of CVC placement using the landmark technique was its misplacement into the vertebral vein with subsequent subdural effusion in a 4-month-old infant[ 11 ].…”