Hydrophilic polymer embolic complication during diagnostic cerebral angiography presenting with delayed intracranial hemorrhage: case report and literature review

Journal of Neurointerventional Surgery
Sameer A AnsariMatthew B Potts

Abstract

We report two serial neuroendovascular cases of hydrophilic polymer embolic complications, and highlight a unique case of a routine diagnostic cerebral angiogram that was complicated by delayed intracranial hemorrhage requiring surgical decompression. Histopathology specimens revealed organized intravascular thrombi with foci of non-polarizable, basophilic foreign material. Shavings from the hydrophilic coatings of a standard diagnostic catheter and guidewire share histologic characteristics with this intravascular foreign material, confirming the diagnosis of hydrophilic polymer emboli. While this phenomenon has been described for complex neurointerventional procedures, it is rare with routine diagnostic cerebral angiography. Along with a detailed literature review, these cases provides further evidence that even basic hydrophilic coated catheters and/or wires may contribute to the etiology of iatrogenic emboli in the neurovasculature with the potential for acute and subacute complications, requiring further investigation.

References

May 29, 2003·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Mark KozakIan C Gilchrist
Sep 1, 2009·Human Pathology·Rupal I MehtaWilliam H Yong
Sep 25, 2009·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Daniel Sado, Fraser Witherow
Oct 23, 2009·American Journal of Clinical Pathology·Robert W AllanHenry D Tazelaar
Mar 23, 2010·Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc·Rupal I MehtaMichael C Fishbein
Aug 2, 2017·Cardiovascular Pathology : the Official Journal of the Society for Cardiovascular Pathology·Amitabh M ChopraHarry V Vinters

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Citations

Feb 1, 2020·AJNR. American Journal of Neuroradiology·A IkemuraY Murayama
Mar 17, 2021·Journal of Neurointerventional Surgery·Therese BoyleKen Faulder
May 28, 2021·Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences·Rasmus Holmboe DahlGoetz Benndorf

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