F oreign body embolization is an unfortunate event that can complicate endovascular procedures. Intraluminal foreign bodies in the cerebral circulation are primarily described in the trauma, neurointerventional, and cardiac literature, although their true prevalence and incidence are unknown. There are no treatment guidelines for foreign body removal, and management depends on surgeon preference, previously described cases, and patient characteristics. We describe an unusual case of a guidewire introducer from a previous cardiac procedure that embolized within the right common carotid artery (CCA), causing the patient to experience a transient ischemic attack (TIA), and was surgically removed via a carotid cutdown approach.
Case ReportHistory and Examination. A 64-year-old man presented to our facility with transient left-sided weakness and slurred speech consistent with a TIA several months after he had undergone complex mitral valve repair. The previous operation involved placement of a left-sided internal jugular venous catheter and a femoral artery cutdown for placement of an endovascular balloon in the aorta for cardiopulmonary bypass during the procedure. Postoperatively, the patient was treated with warfarin for 3 months. At the time of our examination, his National Institutes of Health Stroke Scale (NIHSS) score was 0, with no leftsided hemiparesis.Carotid cutdown for surgical retrieval of a guidewire introducer: an unusual complication after mitral valve repair
Department of Neurosurgery, Buffalo General Medical Center and Gates Vascular Institute at Kaleida Health, Buffalo, New YorkWith the use of endovascular techniques and indwelling catheters, potential complications can include embolization of fragments or components of various systems. The authors describe the surgical retrieval of a guidewire introducer from the right common carotid artery (CCA). A 64-year-old man was found to have a foreign body within the right CCA on CT angiography after he had presented with a transient ischemic attack. He had undergone a complex mitral valve repair several months before presenting to the authors' facility. That procedure involved a femoral artery cutdown and the insertion of an endovascular aortic balloon for cardiac bypass. As in most endovascular procedures, guidewire introducers were probably used to facilitate the introduction of the guidewire into the system during the procedure. Although rare, iatrogenic embolization of the introducer probably occurred during use of the guidewire. The guidewire introducer was successfully retrieved without complication by using a standard carotid cutdown approach. It is extraordinarily unusual for an extracorporeal part of an implantable system to embolize to the carotid circulation. To the authors' knowledge, this is the only reported case of an embolized guidewire introducer and the use of a carotid exposure to retrieve an intraluminal foreign body. This case demonstrates that a carotid cutdown approach can be used successfully for the retrieval of intraluminal extr...