445: Intravascular Catheter Retention Following Failed Mechanical Thrombectomy in Acute Ischemic Stroke

Introduction: Mechanical thrombectomy (MT) is the standard of care for acute ischemic stroke (AIS) due to large vessel occlusion (LVO), significantly improving functional outcomes. While generally safe, MT carries procedural risks including arterial dissection, hemorrhagic transformation, and, rarely, catheter fracture with intravascular retention. Prompt recognition and multidisciplinary management are critical to mitigating morbidity. Description: A 72-year-old female with hypertension presented with acute right-sided weakness, facial droop, and confusion. Examination revealed GCS 11 and NIHSS 23; blood pressure was 241/99 mmHg. Non-contrast CT showed no hemorrhage, and CT angiography revealed left internal carotid artery (ICA) occlusion at the skull base. She was ineligible for intravenous thrombolysis due to refractory hypertension. Neurologic status deteriorated, requiring intubation and emergent MT. During aspiration thrombectomy with a RED 72 catheter, the device fractured, leaving a retained segment extending from the cervical ICA to the left MCA origin, confirmed on CT. Despite intensive neurocritical care, she developed malignant cerebral edema with progressive midline shift (1.5→8.2 mm), necessitating decompressive hemicraniectomy. Postoperatively, she remained comatose (GCS 3), requiring tracheostomy and PEG placement. Transition to hospice occurred after minimal neurologic recovery. Discussion: Catheter fracture during MT is rare, occurring in 0.6%–3.9% of procedures. Retained device fragments may worsen ischemia, promote embolic events, and exacerbate cerebral edema. Endovascular retrieval with snares, baskets, or balloon-assisted techniques is preferred but not always feasible; surgical removal may be required. This case highlights the importance of procedural vigilance, early complication recognition, and coordinated neurocritical and surgical care.