Title |
Foreign Body Emboli following Cerebrovascular Interventions: Clinical, Radiographic, and Histopathologic Features
|
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Published in |
American Journal of Neuroradiology, August 2015
|
DOI | 10.3174/ajnr.a4415 |
Pubmed ID | |
Authors |
M. Shapiro, M.D. Ollenschleger, C. Baccin, T. Becske, G.R. Spiegel, Y. Wang, X. Song, E. Raz, D. Zumofen, M.B. Potts, P.K. Nelson |
Abstract |
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. |
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Unknown | 16 | 31% |
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Unknown | 22 | 42% |