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Case series
Hydrophilic polymer embolic complication during diagnostic cerebral angiography presenting with delayed intracranial hemorrhage: case report and literature review
  1. Sameer A Ansari1,2,3,
  2. Richard R Anderson4,
  3. Michael J Caron3,5,
  4. Ali Shaibani1,3,
  5. Michael C Hurley1,3,
  6. Babak S Jahromi1,3,
  7. Matthew B Potts1,3
  1. 1 Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2 Department of Neurology, Northwestern University Feinberg School of Medicine, Naperville, Illinois, USA
  3. 3 Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  4. 4 Department of Pathology, Edward-Elmhurst Health, Naperville, Illinois, USA
  5. 5 Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Naperville, Illinois, USA
  1. Correspondence to Dr Sameer A Ansari, Departments of Radiology, Neurology, and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; s-ansari{at}northwestern.edu

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.

  • catheter
  • complication
  • device
  • embolic
  • material
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Footnotes

  • Contributors All authors of this manuscript have contributed to the work as per the following ICMJE recommendations: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data; drafting the work or revising it critically for important intellectual content; final approval of the version published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SAA is the guarantor of the manuscript and conceptualized the work. SAA, MBP, and BSJ performed the literature search and/or contributed to manuscript writing. RRA and MJC acquired and/or analyzed pathological tissue/foreign body specimens and prepared histopathological slides, and contributed to manuscript editing. MJC, AS, and MCH identified and managed the cases, and contributed to manuscript editing.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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