title: Iatrogenesis imperfecta: stroke caused by accidental carotid artery catheterization.
abstract: OBJECTIVE
  Central venous catheterization is a commonly used procedure to gain access to the central circulation. Although ultrasound guidance decreases the complication rates, arterial puncture may still occur. Failure to recognize this early may lead to devastating complications such as thrombosis and embolic stroke. We discuss the factors associated with increased risk of arterial puncture, techniques to detect them early and the management of established carotid artery cannulation.
  
  
  METHODS
  We report a case of internal jugular catheterization complicated by carotid artery puncture leading to embolic stroke.
  
  
  RESULTS
  Arterial catheterization in the patient went unrecognized for 2 days. During this period, the patient developed catheter-related thrombus in the carotid artery, ultimately resulting in embolic stroke. Emergent open surgical repair of the vessels with thrombectomy was performed.
  
  
  CONCLUSIONS
  Even with ultrasound-guided central venous catheterization, it is essential to remain vigilant for the early detection of vascular complications. Clinical suspicion combined with diagnostic modalities such as chest radiograph, transduction and manometry can increase the detection rates.
authors.affiliation: Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania - USA.
authors.forename: Ranjan
authors.initials: R
authors.lastname: Pathak
authors.forename: Paras
authors.initials: P
authors.lastname: Karmacharya
authors.forename: Madan Raj
authors.initials: MR
authors.lastname: Aryal
authors.forename: Richard
authors.initials: R
authors.lastname: Alweis
mesh_terms: D020212:Carotid Artery Injuries / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D038524:Diffusion Magnetic Resonance Imaging; D004630:Emergencies; D017809:Fatal Outcome; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D017131:Thrombectomy; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery