Digital subtraction angiography (DSA) is nowadays a gold standard for the detection of intracranial artery stenosis, and is gaining popularity because of its safety and minimally invasive advantages. Nevertheless, infrequent but catastrophic complications have been reported, including fragments of the catheter or guidewire forming intravascular foreign bodies, which sometimes lead to cardiac arrhythmia and thromboembolism. Few studies have described the angiographic guidewire completely falls off and enters artery with secondary thrombosis. It is probably because this type of injury is really rare, the patient has not received timely treatment and it is also difficult to be removed through surgery.
Once IAFB is diagnosed, it should be removed as soon as possible to prevent potentially fatal complications, including pulmonary, cerebral, or peripheral arterial embolism secondary to thrombosis, sepsis, malignant arrhythmia, endocarditis, ventricular perforation, or even heart tamponade. In our case, the patient underwent cerebrovascular angiography and the guidewire fell off in the aorta unfortunately, which formed thrombus and caused new cerebral infarctions 4 months later. After retrieving the guidewire, the patient lived freely with no new cerebral infarction.
Due to the rarity of intravascular foreign bodies, the treatment is still challenging. Kashif et al. had described retrieval of a missing guidewire from the left arm under fluoroscopic guidance through a percutaneous procedure.  This is also emphasized by other reports that percutaneous minimally invasive surgery is commonly used to remove intravascular foreign bodies, including broken catheters, guidewires, dislocated stents, intraluminal filters and occluders. However, such method is not suitable for our patient. First, the guidewire extended from the internal carotid artery to the descending aorta, and was folded into three sections within the descending aorta. Second, the guidewire remained in aorta for 8 months, and formed adhesion with the vascular intima. Compared to intravascular retrieval techniques, open retrieval is more effective in stents, vertebroplasty cement, Inferior vena cava filters and guidewires. The choice of opening or intravascular retrieval depends on the position, location, degree of organ involvement, and the type and shape of foreign bodies in the vessels. Therefore, in our case, the use of percutaneous minimally invasive surgery will have great difficulties and risks, which may easily cause artery rupture, but open retrieval could better decrease the risk of artery scratch or even rupture to reduce mortality.