Fragmentation, disconnection, or entrapment of an in-use microcatheter during neuro-endovascular procedures, whether spontaneously or purposefully, is a known complication. Retained catheters are often a benign entity, but severe complications necessitating retrieval1, 2, 3 have been described, including thrombus, thromboembolic events, pseudoaneurysm, and limb ischemia. Current management paradigms are not standardized and include observation, endovascular retrieval (snare techniques,4 retrieval forceps,5 or the use of balloon microcatheters for counter traction6), and open retrieval. Typically, open surgical resection is the last resort. This technical case note seeks to demonstrate the successful use of open microsurgical exploration and removal of a microcatheter via an external carotid artery approach using live intraoperative fluoroscopy.