Fracture and migration of a retained wire into the thoracic cavity after endovascular neurointervention: report of 2 cases

Abstract

Although extremely rare, retention of foreign bodies such as microcatheters or micro guidewires can occur during various neurovascular procedures due to gluing of the microcatheter tip or entanglement of the micro guidewire tip with intravascular devices. The authors have experienced 2 cases of irresolvable wire retention, one after flow diverter placement for a left cavernous internal carotid artery aneurysm and the other after intracranial stenting for acute basilar artery occlusion. The first patient presented 6 weeks after her procedure with right lung parenchymal hemorrhage due to direct piercing of the lung parenchyma after the retained wire fractured and migrated out of the aortic arch. The second patient presented 4 years after his procedure with pneumothorax due to migration of the fractured guidewire segment into the right thoracic cavity. In this report, the authors discuss the possible mechanisms of these unusual complications and how to prevent delayed consequences from a retained intravascular metallic wire.