The Use of Microsurgical Exploration of the External Carotid Artery for Removal of a Retained Microcatheter After Middle Meningeal Artery Embolization Using Live Fluoroscopy: A Technical Note

Background Fragmentation, disconnection, or entrapment of an in-use micro catheter during neuro-endovascular procedures is a known risk. Often a benign entity, retained catheters are not infrequently observed but severe complications including thrombus, thromboembolic events, pseudoaneurysm, and limb ischemia have been described, necessitating retrieval. This technical case report demonstrates the safe use of an external carotid artery approach for ligation and removal of a retained microcatheter after middle meningeal artery embolization. This article also demonstrates the use of live intraoperative fluoroscopy as a surgical adjunct to ensure the catheter is fully removed without any injury, shearing, or breakage during removal. Methods A 66-year-old male presented with bilateral subdural hematomas to an outside hospital. He subsequently underwent evacuation of the hematomas followed by a right sided MMA embolization, complicated by onyx entrapment of the microcatheter in the MMA. The patient was asymptomatic, but there was significant concern about continuing antiplatelet/anticoagulation therapy in the presence of the subdural hematoma. We proceeded with an open surgical approach for catheter retrieval. As the catheter was withdrawn, intraoperative fluoroscopy demonstrated complete removal without any retained fragments. Results The patient recovered without event and was discharged on post-operative day one. On follow-up the patient continued to do well without any complications from the fragment that remained in the external carotid circulation. Conclusion This case and accompanying video demonstrates the effective use of open ECA surgical approach to retrieve the retained microcatheter after an MMA embolization. This approach allowed for safe and effective removal of the microcatheter while significantly reducing complication risks.