Wingspan stent delivery catheter fracture and the TRAP technique for endovascular salvage

• Published in: Interventional neuroradiology Vol. 24; no. 1; pp. 106 - 110
• Main Authors: Jagani, Manoj, Do, Huy M, Heit, Jeremy J
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.02.2018
• Subjects: Aged; Angiography, Digital Subtraction; Catheters - adverse effects; Cerebral Angiography; Computed Tomography Angiography; Device Removal; Diffusion Magnetic Resonance Imaging; Endovascular Procedures - methods; Equipment Failure; Foreign Bodies - diagnostic imaging; Foreign Bodies - therapy; Humans; Infarction, Middle Cerebral Artery - diagnostic imaging; Infarction, Middle Cerebral Artery - surgery; Intracranial Arteriosclerosis - diagnostic imaging; Intracranial Arteriosclerosis - surgery; Magnetic Resonance Angiography; Miscellaneous; Stents - adverse effects; Tomography, X-Ray Computed; intracranial atherosclerotic disease; Stroke; Wingspan; foreign body; angioplasty
• ISSN: 1591-0199; 2385-2011
• DOI: 10.1177/1591019917737734

Background Intracranial atherosclerotic disease may result in ischemic infarction and has a high rate of recurrent ischemic strokes despite medical therapy. Patients who fail medical therapy may undergo endovascular treatment with cerebral artery angioplasty and possible Wingspan stent placement. We present a unique case of Wingspan delivery microcatheter fracture that resulted in a retained foreign body and an endovascular salvage maneuver. Case description An elderly patient presented with an acute ischemic stroke due to a severe stenosis in the proximal left middle cerebral artery (MCA). The patient failed non-invasive medical treatment and underwent endovascular treatment with angioplasty and Wingspan stent placement. Following Wingspan stent deployment, the stent delivery catheter fractured, and the retained catheter fragment resulted in MCA occlusion. The foreign body was retrieved by balloon catheter inflation within an intermediate catheter adjacent to the proximal end of the fractured catheter and removal of the entire construct (TRAP technique). Conclusions Wingspan delivery microcatheter fracture is a rare event. The TRAP technique may be used for successful retrieval of a retained foreign body.