Case studyIntravascular polymer material after coil embolization of a giant cerebral aneurysm☆,☆☆
Introduction
Hydrophilic polymer materials of various composition have long been applied as coating to endovascular devices to ease navigation within tortuous vessels, decrease endothelial trauma, and reduce intraprocedural thrombotic phenomena. Their use has allowed for advancements in transradial approach during cardiac catheterization. Polymer-coated aneurysm coils, such as Hydrocoils (Terumo Medical, Microvention, Aliso Viejo, CA), have been shown to facilitate volumetric occlusion of aneurysms by inducing inflammation and thrombus organization, which according to some studies, allows for use of less total coil material, decreasing associated risks [1].
A prospective randomized trial has shown that endovascular embolization of ruptured aneurysms is associated with reduced morbidity/mortality compared with surgical clipping [2]. However, iatrogenic embolization of polymer gel is associated with endovascular surgeries, and the frequency of resulting tissue infarction may be underrecognized. We describe the first case of coil embolization in which widespread deposition of polymer gel occurred within intracerebral blood vessels, contributing to death of the patient.
Section snippets
Case summary
The decedent was an 87-year-old female (nonsmoker) with a history of hypertension, peripheral vascular disease, chronic renal insufficiency, coronary artery disease, and congestive heart failure, and a 20-year known history of a surgically untreatable intracranial aneurysm. She presented to an outside hospital 14 days before death, reporting acute onset of severe headache and neck stiffness. Imaging studies showed Fisher grade 4 subarachnoid hemorrhage, with a ruptured left supraclinoid carotid
Autopsy findings
General autopsy revealed cyanosis of the fingertips and necrosis of the tongue. There was ulcerative atherosclerosis of the aorta with an infrarenal abdominal aortic aneurysm (6 cm), organizing pneumonia, bilateral renal cortical retention cysts, and cardiac hypertrophy with patent foramen ovale (heart weight, 455 g; left ventricular wall thickness, 2.0 cm).
Examination of the brain showed a left supraclinoid (bilobed) 2.9-cm aneurysm with diffuse softening of the left parieto-occipital lobes
Microscopic examination of medical devices
An unused Matrix2 coil was flushed with phosphate buffer saline. One segment of coil was stretched by pulling opposite ends apart with forceps. The segment was then stained with hematoxylin and eosin, mounted on a glass slide, and coverslipped. A steel blade was used to scrape off coating from other segments of coil, yielding strips of gel which were submitted for routine tissue processing (ie, the material was formalin fixed, paraffin embedded, sectioned, mounted on a glass slide, stained with
Discussion
The Matrix2 detachable coil (Boston Scientific Neurovascular, Fremont, CA) was approved by the United States Food and Drug Administration in 2002 and consists of a platinum core lined by polysorb (biodegradable polymer composed of 90% polyglycolic acid and 10% polylactic acid). The coated coils, as well as concurrently used polymer-coated supplies (such as microcatheters and guidewires), account for a surface area totaling several meters in length. The abundant amount of gel used during a
Summary
We describe the first case of coil embolization for intracerebral aneurysm in which polymer material deposited in unpredictable arterial sites, inducing granulomatous reaction and scattered infarcts in the brain, brainstem, and cerebellum. We have observed similar findings in several other patients who underwent interventional procedures at University of California, Los Angeles, Medical Center during the past 2 years; this is the subject of ongoing investigations.
The frequency of the discussed
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2021, Clinical Neurology and NeurosurgeryA polyethylene glycol functionalized hyaluronic acid coating for cardiovascular catheter lubrication
2020, Materials and DesignCitation Excerpt :Catheters are directly in contact with biological fluids such as blood or urine during intervention [3] and the friction between catheter and tissue may induce vasoconstriction and vessel wall injury [4,5]. To maintain safe catheterization, hydrophilic and highly lubrication coatings are used clinically for the catheters, although recently many reports warned the scientific community of the iatrogenic complications due to particulate release in the blood stream causing embolization [6,7] with further ramifications [8–11]. Surface modification technology [12–16] to develop thin (non-swelling) coatings has been used to improve the tribological performance of device and catheter for some time.
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The authors have no conflicts of interest to disclose.
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This work is supported by the Translational Research Fund (TRF) sponsored by the Department of Pathology and Laboratory Medicine at University of California, Los Angeles, CA (R.I.M., R.I.M., H.V.V.). HVV is supported, in part, by the Daljit S. and Elaine Sarkaria Chair in Diagnostic Medicine. HVV and WHY are supported, in part, by University of California, Los Angeles, SPOTRIAS grant NS044378.