Polymer Embolization From Minimally Invasive Interventions

Sequeira, Adrian; Parimoo, Nakul; Wilson, Jon D.; Traylor, James; Bonsib, Stephen M.; Abreo, Kenneth

doi:10.1053/j.ajkd.2012.12.021

Cited by 40 publications

(33 citation statements)

References 10 publications

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“…[3][4][5][6][7] Although these reports only described a limited number of patients, similar findings have been reported to be related to other vascular procedures in which hydrophilic-coated materials were used. Such reports include neurointerventional procedures and percutaneous procedures of the lower extremities, in which embolized foreign materials were found in the microvasculature of the lower extremities, brains, and lungs during histopathologic evaluation of biopsies or at autopsy.…”

supporting

confidence: 70%

“…On autopsy, cylindrical, coiled, basophilic material was seen in the myocardium of the anterolateral wall. 6 The last report we found described a 65-year-old male patient who died 1 month after PCI of the RCx. Autopsy revealed multiple basophilic filamentous to amorphous granular material with an inflammatory giant cell response within the myocardial territory of the RCx artery.…”

Section: Previous Reportsmentioning

confidence: 96%

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Distal Embolization of Hydrophilic-Coating Material From Coronary Guidewires After Percutaneous Coronary Interventions

Grundeken

Kurpershoek

et al. 2015

Circ: Cardiovascular Interventions

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Background— Coronary guidewires are indispensable during percutaneous coronary interventions. Nowadays, most guidewires have hydrophilic coatings to improve their trackability, allowing easy lesion passage and facilitating balloon and stent positioning. Recent reports, however, have raised concerns about detachment and subsequent embolization of these hydrophilic coatings. Methods and Results— We have retrospectively reviewed the histological samples of the myocardium, obtained during autopsies in the period 2009 to 2013, from all patients who had a history of percutaneous coronary interventions (n=40). Foreign material was observed in the distal myocardium in 4 patients (10%). Furthermore, we have reviewed 205 thrombus specimens which were obtained during thrombus aspiration in the setting of primary percutaneous coronary interventions in the period 2005 to 2009. In 45% of the cases, foreign material was observed within the thrombus. Finally, we have examined the histopathologic appearance of hydrophilic-guidewire coating material ex vivo by embedding the coating in placenta specimen and cut and stain it in exactly the same manner as the myocardium and thrombus specimen. The histopathologic appearance of the hydrophilic coating ex vivo was identical to the foreign material found in vivo. Conclusions— Distal embolization of hydrophilic-coating material was observed in 10% of the patients who had a history of percutaneous coronary interventions. Hydrophilic-coating material was found in 45% of coronary thrombus specimen obtained during thrombus aspiration. These findings suggest that detachment and distal embolization of hydrophilic-coating material from coronary guidewires occur more often than the sparse literature on this topic suggests.

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supporting

confidence: 70%

Section: Previous Reportsmentioning

confidence: 96%

Distal Embolization of Hydrophilic-Coating Material From Coronary Guidewires After Percutaneous Coronary Interventions

Grundeken

Kurpershoek

et al. 2015

Circ: Cardiovascular Interventions

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“…Pathological examination of these lesions demonstrates prominent foreign-body granulomatous reaction in response to dislodged hydrophilic coating [4]. Such foreignbody granulomatous reaction to hydrophilic coating has also been reported in the myocardium [29][30][31], kidneys [31], and lungs [32] after cardiac and peripheral endovascular procedures. Fealey et al and Shapiro et al have reported three cases of delayed NICE lesions after EVT with pathological examination of the lesions [4,6].…”

Section: Discussionmentioning

confidence: 79%

Non-ischemic cerebral enhancing lesions secondary to endovascular aneurysm therapy: nickel allergy or foreign body reaction? Case series and review of the literature

et al. 2016

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“…This was found to be due to loss of the hydrophilic coating from the catheter sheaths [2][3][4]. A recent article in renal medicine literature found histopathological evidence of hydrophilic coating polymer emboli within an arteriovenous graft, a transplanted kidney, and the myocardium following renal interventional procedures [5].…”

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confidence: 99%

Suspected cerebral foreign body granuloma following endovascular treatment of intracranial aneurysm: imaging features

et al. 2014

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Dear Sir, Coil occlusion of aneurysms has emerged as the mainstay of treatment following the ISAT trial [1]. Advances in technology have facilitated the endovascular treatment of complex and broad necked aneurysms.These procedures often require the simultaneous placement of several pieces of equipment within the intracranial vessels for a prolonged period of time.Usually, complications after these procedures are more frequent but otherwise do not differ from simple coiling.We wish to report a rare complication in a patient after a complex procedure in tortuous anatomy.A 51-year-old woman had previously been treated at our institution after a subarachnoid haemorrhage. While the site of rupture was unknown, a proximal right A1 aneurysm and a left paraophthalmic aneurysm were both secured with bare platinum coils in one sitting.A recurrence of the A1 aneurysm was observed after 6 months and following multidisciplinary discussion, the patient consented to retreatment with stent assisted coiling using Leo + Baby low profile nitinol braided self expanding stent (Balt, Montmorency, France).The patient was pretreated with dual antiplatelets for 7 days (aspirin 75 mg OD and Clopidogrel 75 mg OD). The procedure was performed under general anaesthetic, and the patient was anticoagulated during the procedure with heparin, maintaining the activated clotting time (ACT) twice above baseline.A Fargo (Balt, Montmorency, France) distal access catheter was placed into the right internal carotid artery, and an Echelon-10 (ev3 Endovascular, Plymouth, MN, USA) was advanced into the distal right A1 over a Traxess guidewire (Microvention, Tustin, CA, USA). The placement of this equipment was difficult due to severe tortuosity of the aortic arch and supra-aortic vessels.The Leo + Baby stent was placed across the aneurysm neck in a good position. However, despite multiple attempts, the aneurysm could not be cannulated with a guidewire through the struts of the stent, and therefore, no coiling was performed.The patient was well following the procedure and was discharged 2 days later without complication.Two weeks later, the patient presented to her local hospital with two generalised seizures preceded by a prodrome of malaise, headache, and mild right sided weakness.A CT revealed several areas of cortical and white matter low attenuation within the right cerebral hemisphere. Magnetic resonance imaging of the brain demonstrated several areas of cortical and white matter T2 hyperintensity surrounding multiple lesions that exhibited nodular and peripheral rim enhancement (Fig. 1). Many of these lesions contained a central area of susceptibility artefact on gradient echo (Fig. 1b), which persisted after the resolution of oedema and contrast enhancement (Fig. 1d). The lesions were restricted to the territory of the right internal carotid artery.The patient received empirical treatment with broad spectrum antibiotics on the assumption that these lesions were infective abscesses. However, the blood inflammatory markers were not increased and bloo...

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Polymer Embolization From Minimally Invasive Interventions

Cited by 40 publications

References 10 publications

Distal Embolization of Hydrophilic-Coating Material From Coronary Guidewires After Percutaneous Coronary Interventions

Distal Embolization of Hydrophilic-Coating Material From Coronary Guidewires After Percutaneous Coronary Interventions

Non-ischemic cerebral enhancing lesions secondary to endovascular aneurysm therapy: nickel allergy or foreign body reaction? Case series and review of the literature

Suspected cerebral foreign body granuloma following endovascular treatment of intracranial aneurysm: imaging features

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