Carotid cutdown for surgical retrieval of a guidewire introducer: an unusual complication after mitral valve repair

Case report

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  • 1 Departments of Neurosurgery,
  • 2 Radiology, and
  • 3 Neurology, School of Medicine and Biomedical Sciences;
  • 5 Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York; and
  • 4 Department of Neurosurgery, Buffalo General Medical Center and Gates Vascular Institute at Kaleida Health, Buffalo, New York
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With 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 extracranial carotid artery foreign bodies.

Abbreviations used in this paper:CCA = common carotid artery; ECA = external carotid artery; ICA = internal carotid artery; MCA = middle cerebral artery; TIA = transient ischemic attack.

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Contributor Notes

Address correspondence to: Kenneth V. Snyder, M.D., Ph.D., University at Buffalo Neurosurgery, 100 High St., Ste. B4, Buffalo, NY 14203. email: ksnyder@ubns.com.

Please include this information when citing this paper: published online June 13, 2014; DOI: 10.3171/2014.5.JNS132246.

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