Retrieval of a fractured radial access catheter from the axillary artery

Abstract

Radial access has become more common among interventionalists for neurointerventional procedures due to lower complication rates and patient comfort. ^{1, 2} However, rare but serious complications such as catheter fracture and retention require recognition and investigation of advanced retrieval strategies. ³ We present a two-stage case involving a patient in their 70s who initially underwent successful mechanical thrombectomy for left M1 occlusion. Hours later, new onset of neurological deficits led to repeat digital subtraction angiography via right radial access. During catheter withdrawal and after initial medical management of suspected vasospasm, the RIST guide catheter became entrapped and fractured within the axillary artery. Transfemoral access was used to retrieve the distal catheter fragment using a snare technique. Post-retrieval imaging confirmed vessel integrity, though ulnar artery occlusion led to ischemia requiring vascular surgery. This case illustrates a rare complication of radial access and highlights suspected novel technical considerations for retrieval, rescue planning, and catheter system selection.