Background Cerebral embolism of coating fragments from endovascular devices represent a serious complication to neuroendovascular treatment that may cause ischemic infarction, intraparenchymal hemorrhage, granulomatous angiitis, and non-ischemic cerebral enhancing lesions. Although coating fragments may be created relatively often during neuroendovascular procedures, only few studies have systematically assessed mechanisms responsible for coating damage. We hypothesize that coating fragments may be created when a microguidewire is backloaded through an introducer.

Materials and Methods Eight microguidewires (Asahi Chikai 200 cm, Asahi Chikai Black, Fathom™, Hybrid, Radifocus^® Guide Wire GT, Synchro^2®, Transend™ EX, and Traxcess™) frequently used during endovascular therapy were investigated ex vivo using their dedicated metal or plastic insertion tools to assess for coating delamination after backloading of the microguidewires. Backloading was first performed with a straight microguidewire and subsequently with moderate (15°) and severe (30°) bending of the main body of the microguidewire in front of the insertion tool. After each attempt of backloading, the introducer was flushed with deionized water onto a microscope slide that was imaged with a polarized light microscope (Axio Imager 2 Pol, Zeiss, Oberkochen, Germany).

Results Microscopic fragments were observed after every attempt of microguidewire backloading regardless of manufacturer and whether the microguidewire was straight or bent. Fewest and smallest fragments were observed after backloading of straight (figure 1A) microguidewires, while bending of the main body of the guidewire increased the number and size of fragments (figure 1B). All microguidewires in this study produced filamentous and/or band-like fragments that were consistent with peeled off pieces of the microguidewire’s coating. Filamentous fragments measured 3-15 µm in width and had a length of up to 7 mm. Band-like fragments had a width of 35-115 µm and were more often created when microguidewires were bent during backloading. In addition, the smallest fragments measured 1-3 µm in diameter and were observed for all microguidewires. A few large fragments consisted either of multiple intertwined filaments or a single irregular piece.

Conclusion Backloading of polymer-coated microguidewires during endovascular therapy should be minimized if possible. More stable hydrophilic coatings on microguidewires and less traumatic insertion tools are desirable.

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Abstract O-054 Figure 1

Disclosures R. Holmboe Dahl: None. G. Benndorf: None.