Neuroendovascular Micro-Guide Wire Ramrod Technique for Salvaging Occluded Ventriculostomy Catheters: Technical Note

Introduction: External ventricular drain (EVD) catheters are a cornerstone of neurosurgical perioperative care. Catheter occlusion by blood clot, brain matter or other debris is unfortunately a common and frustrating problem, necessitating catheter exchange and hemorrhagic risk exposure due to the need for insertion of a new catheter. The author describes the use of commonly available neuroendovascular wires for catheter clearance.

Methods: Two different neuroendovascular micro-guide wires, Chikai 0.014” (Asahi) and NeuroSynchro 0.014” (Stryker) were used. In each case, a preexisting EVD had ceased to flow, with occlusion from blood or tumor debris. Using sterile technique, the catheter was disconnected from the drainage tubing. After shaping a gentle “C” curve at the tip, the micro-guide wire was then inserted into the catheter. Flouroscopic imaging in the anterior-posterior view was used to follow the wire tip into the distal ventricular catheter, and then out the side inlets. A gentle back and forth motion of the wire was then used to dislodge the blockage, as well as rotation to allow wire entry into successive inlets. In both cases, flow was reestablished for a minimum of 24 hours.

Discussion: Neuroendovascular micro-guide wires have multiple advantages as a tool to clear a clogged EVD. First, the tip is extremely soft and atraumatic, as these wires are designed to enter into ruptured cerebral aneursyms. Hence, if the wire contacts the ependymal wall, it will typically deform upon itself, as opposed to dissecting and entering into the brain. Second, the wires are highly radio-opaque, and thus can be easily tracked under even portable fluoroscopic units. Third, the wires are highly flexible, and will easily navigate through a looped catheter. Fourth, the wires are available at any hospital that has a neuroendovascular service line. If the wire technique is successful in relieving the clog, then the patient will be spared the risk of a new catheter insertion, which will ultimately decrease complication rates.