Retained Microcatheter During n-Butyl Cyanoacrylate Embolization of a Ruptured Distal Posterior Cerebral Artery Aneurysm: A Case Report With 4-Year Follow-Up

Cerebral endovascular interventions provide a safe and effective means of treating intracranial vascular pathologies, including cerebral aneurysms. However, in cases of intraoperative iatrogenic rupture, treatment options may be limited. Embolization using <i>n</i>-butyl cyanoacrylate liquid embolic agent can be a safe and timely option. A rare complication of this therapy is microcatheter entrapment. We present a case of a 66-year-old female who presented with a ruptured distal posterior cerebral artery aneurysm. During coil embolization via a radial approach, intraoperative rupture occurred. <i>n</i>-Butyl cyanoacrylate was used to control the rupture, but the microcatheter became adherent to the embolic material. The microcatheter was sectioned at the wrist and retained. The patient was managed with aspirin and followed with serial imaging for 4 years, demonstrating the safety of this conservative management. Retained microcatheter is an uncommon but known risk, and this case demonstrates the long-term safety of sectioning a retained microcatheter traversing the radial, vertebral, basilar, and posterior cerebral arteries, representing one of the longest follow-up periods to date in the literature for such a case.