Retrieval of n-Butyl Cyanoacrylate Cast Migrated to the Dorsalis Pedis and Posterior Tibial Artery During Embolization of the Deep Circumflex Iliac Artery Using the Stent Retriever Device: A Case Report

Abstract

N-butyl cyanoacrylate (NBCA) is commonly used in interventional radiology procedures for its efficacy in vessel occlusion, yet it poses risks of embolic material migration. We present a unique case of NBCA cast migration during deep circumflex iliac artery (DCIA) embolization, leading to occlusion of the dorsalis pedis and posterior tibial arteries, subsequently retrieved using a stent retriever device. A 68-year-old woman with a history of heart valve replacement presented with a large intramuscular hematoma. N-butyl cyanoacrylate embolization of DCIA resulted in cast migration, occluding distal arteries. Retrieval was attempted using a stent retriever device, successfully restoring arterial flow. N-butyl cyanoacrylate use necessitates attention to vascular anatomy and test injections to mitigate complications. Stent retriever devices, originally designed for acute stroke thrombectomy, offer a viable solution for embolic material retrieval in vascular interventions. This case highlights successful NBCA cast retrieval in lower extremity arterial occlusion using a stent retriever device. Prompt recognition and intervention are crucial in mitigating complications associated with NBCA use. Stent retriever devices present a valuable tool for NBCA cast retrieval, preserving arterial perfusion in affected areas. Clinical Impact This case highlights the innovative application of stent retriever devices for retrieving migrated NBCA casts, traditionally used for stroke management in peripheral arterial occlusions. This adaptation offers clinicians a new, effective tool for managing embolization complications, such as unintended material migration that can cause severe ischemia. Implementing this technique could change clinical practice by providing a reliable method to swiftly address and resolve potentially limb-threatening situations, thereby improving patient outcomes and procedural safety. This advancement in interventional radiology enhances clinicians’ ability to handle complex embolic events with greater confidence and efficacy.