Foreign Body Emboli following Cerebrovascular Interventions: Clinical, Radiographic, and Histopathologic Features

Abstract
SUMMARY: Foreign material emboli following cerebral, cardiac, and peripheral catheterizations have been reported since the mid-1990s. Catheter coatings have been frequently implicated. The most recent surge of interest in this phenomenon within the neurointerventional community is associated with procedures using flow-diversion devices for the treatment of cerebral aneurysms. Following coil-supported Pipeline embolization in 4 cases and stent-supported coiling in 1, 5 patients developed multiple subcentimeter enhancing lesions, usually with surrounding edema and variable magnetic susceptibility in the vascular territories of the treated aneurysms. Conventional angiography findings were unrevealing. Laboratory work-up showed mild CSF protein elevation with no leukocytosis. Brain biopsy in 2 cases revealed granulomatous angiitis encasing foreign material, identical in stain appearance to a polyvinylpyrrolidone catheter coating. Corticosteroid administration typically produced clinical improvement. A heterogeneous radiographic and clinical course was noted, with rise and fall in the number of enhancing lesions in 2 patients and persistence in others. The etiology may be related to widespread adoption of increasingly sophisticated catheterization techniques.
Abbreviations
- PRU
- P2Y12 reaction units
- PVP
- polyvinylpyrrolidone
- © 2015 American Society of Neuroradiology
Jump to section
Related Articles
- No related articles found.
Cited By...
- Correspondence on 'Non-ischemic cerebral enhancing (NICE) lesions after flow diversion for intracranial aneurysms: a multicenter study by Richter et al
- Non-ischemic cerebral enhancing (NICE) lesions after flow diversion for intracranial aneurysms: a multicenter study
- Longitudinal radiological follow-up of individual level non-ischemic cerebral enhancing lesions following endovascular aneurysm treatment
- Non-ischemic cerebral enhancing lesions after intracranial aneurysm endovascular repair: a retrospective French national registry
- Medical treatment of polymeric cerebral granulomatous reactions following endovascular procedures
- Polymer degradation rates and persisting brain lesions post endovascular procedures
- Iatrogenic Foreign Materials Associated with Retrieved Clot Tissue via Mechanical Thrombectomy
- Microcatheter Originating Debris during Neuroendovascular Procedures: Mechanism of Dislodgement and Its Prevention
- Suspected Metallic Embolization Distal to Coiled Intracranial Aneurysms Detectable by Susceptibility-Weighted MR Imaging
- Delayed Leukoencephalopathy: A Rare Complication after Coiling of Cerebral Aneurysms
- Intrathrombus polymer coating deposition: a pilot study of 91 patients undergoing endovascular therapy for acute large vessel stroke. Part I: Histologic frequency
- Hydrophilic polymer embolic complication during diagnostic cerebral angiography presenting with delayed intracranial hemorrhage: case report and literature review
- Delayed leucoencephalopathy after coil embolisation of unruptured cerebral aneurysm
- Delayed neurological deficits after endovascular placement of a pipeline embolisation device: clinical manifestation and treatment
- Delayed enhancing lesions after coil embolization of aneurysms: clinical experience and benchtop analyses
- Risk Factors for Ischemic Complications following Pipeline Embolization Device Treatment of Intracranial Aneurysms: Results from the IntrePED Study
This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking.