Patient underwent an endovascular coiling of a ruptured right internal carotid artery aneurysm in (b)(6) 2017.She was brought back to the same facility for elective endovascular flow diverting pipeline stent embolization for treatment of the residual right internal carotid artery aneurysm on (b)(6) 2018.During the procedure, a neuron max 6 f 80 cm sheath taken over penumbra select 5f diagnostic catheter from the right groin into the right common carotid artery.The physician noticed the distal tip of the radio-opaque marker of the neuron max sheath had separated from the catheter and had migrated into the right middle cerebral artery.During the attempts to retrieve the radio-opaque marker, the posterior division of the r middle cerebral artery was dissected with subsequent subarachnoid hemorrhage noted.The neuro interventionalist aborted the procedure, left the marker remaining within the vessel, and reversed the heparin.The patient was taken to icu intubated on a mechanical ventilator.Ct revealed herniation of the brain; therefore, an emergency right hemi-craniectomy was performed on (b)(6) 2018.Currently the patient is being weaned off the ventilator and is following simple commands with left hemiparesis.On (b)(6) 2018 - ct brain - intraparenchymal hemorrhage right frontal lobe with adjacent subarachnoid hemorrhage and 2 mm herniation (b)(6) 2018 - cp brain - acute right sided middle cerebral artery infarct (b)(6) 2018 - ct brain - stable right intraparenchymal hematoma and right middle cerebral artery infarct with decrease in midline shift.
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