Autopsy demonstration of intramyocardial polymer gel emboli associated with a giant-cell reaction following cardiac catheterization: a case report

El-Najjar, Vicky; Robinson, Morton J.

doi:10.1016/j.carpath.2011.05.005

Cited by 31 publications

(23 citation statements)

References 3 publications

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“…[3][4][5][6][7] Although these reports only described a limited number of patients, similar findings have been reported to be related to other vascular procedures in which hydrophilic-coated materials were used. Such reports include neurointerventional procedures and percutaneous procedures of the lower extremities, in which embolized foreign materials were found in the microvasculature of the lower extremities, brains, and lungs during histopathologic evaluation of biopsies or at autopsy.…”

supporting

confidence: 71%

“…Autopsy revealed multiple basophilic, amorphous, focally lamellated, focally granular material in the microvasulature of the myocardium with an inflammatory component consisting of giant cells and lymphocytes. 3 Another case report described multiple intravascular foreign bodies found in the myocardium of a heart transplantation patient who underwent 32 PCIs in the past. 5 These nonrefractile, nonpolarizable foreign bodies were thought to be derived from the hydrophilic coating of the guidewires used.…”

Section: Previous Reportsmentioning

confidence: 99%

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Distal Embolization of Hydrophilic-Coating Material From Coronary Guidewires After Percutaneous Coronary Interventions

Grundeken

Kurpershoek

et al. 2015

Circ: Cardiovascular Interventions

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Background— Coronary guidewires are indispensable during percutaneous coronary interventions. Nowadays, most guidewires have hydrophilic coatings to improve their trackability, allowing easy lesion passage and facilitating balloon and stent positioning. Recent reports, however, have raised concerns about detachment and subsequent embolization of these hydrophilic coatings. Methods and Results— We have retrospectively reviewed the histological samples of the myocardium, obtained during autopsies in the period 2009 to 2013, from all patients who had a history of percutaneous coronary interventions (n=40). Foreign material was observed in the distal myocardium in 4 patients (10%). Furthermore, we have reviewed 205 thrombus specimens which were obtained during thrombus aspiration in the setting of primary percutaneous coronary interventions in the period 2005 to 2009. In 45% of the cases, foreign material was observed within the thrombus. Finally, we have examined the histopathologic appearance of hydrophilic-guidewire coating material ex vivo by embedding the coating in placenta specimen and cut and stain it in exactly the same manner as the myocardium and thrombus specimen. The histopathologic appearance of the hydrophilic coating ex vivo was identical to the foreign material found in vivo. Conclusions— Distal embolization of hydrophilic-coating material was observed in 10% of the patients who had a history of percutaneous coronary interventions. Hydrophilic-coating material was found in 45% of coronary thrombus specimen obtained during thrombus aspiration. These findings suggest that detachment and distal embolization of hydrophilic-coating material from coronary guidewires occur more often than the sparse literature on this topic suggests.

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supporting

confidence: 71%

Section: Previous Reportsmentioning

confidence: 99%

Distal Embolization of Hydrophilic-Coating Material From Coronary Guidewires After Percutaneous Coronary Interventions

Grundeken

Kurpershoek

et al. 2015

Circ: Cardiovascular Interventions

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“…Pathological examination of these lesions demonstrates prominent foreign-body granulomatous reaction in response to dislodged hydrophilic coating [4]. Such foreignbody granulomatous reaction to hydrophilic coating has also been reported in the myocardium [29][30][31], kidneys [31], and lungs [32] after cardiac and peripheral endovascular procedures. Fealey et al and Shapiro et al have reported three cases of delayed NICE lesions after EVT with pathological examination of the lesions [4,6].…”

Section: Discussionmentioning

confidence: 91%

Non-ischemic cerebral enhancing lesions secondary to endovascular aneurysm therapy: nickel allergy or foreign body reaction? Case series and review of the literature

et al. 2016

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“…Associated pulmonary intravascular and/or perivascular inflammation was present in 16 decedents (89%) (Figs. 1 and 2) [9,11-14], including macrophages (16 cases, 89%) (Fig. 1C and D); foreign body giant cell reaction (11 cases, 61%) (Figs.…”

Section: Resultsmentioning

confidence: 99%

Hydrophilic polymer embolism and associated vasculopathy of the lung: prevalence in a retrospective autopsy study

et al. 2015

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Hydrophilic polymers are commonly applied as surface coatings on vascular devices and have been shown to dissociate during endovascular use, causing hydrophilic polymer embolism (HPE). Adverse effects related to this phenomenon have been recognized and reported. The prevalence of this complication is unknown. We conducted a retrospective study to determine the prevalence of HPE among hospital autopsies over a 29-month period. Postmortem tissue was histologically evaluated for the presence, location(s) and extent of HPE. HPE findings were correlated with documented clinical and laboratory data and patient outcome. Of 136 hospital autopsies examined, 18 (13%) showed evidence of HPE involving the lungs (n = 18), heart (n = 1) or central nervous system (n = 1). Localized pulmonary HPE was seen in 12 patients (9%). Multifocal pulmonary HPE was found in 6 patients (4%) and was associated with clinical vasculitis (33%; P < .0001), suspected pulmonary ischemia (50%; P = .008), coagulopathy (67%; P = .002), and constitutional disease (83%; P = .01). Within affected lung, associated histopathologic changes included occlusive intravascular or perivascular inflammation (89%), intravascular fibrous response (56%), microthrombus formation (44%), vasculitis (28%), and/or pulmonary microinfarction (28%). Statistically significant differences in hospital days (P = .008) and number of vascular interventions (P = .01) were noted between affected and unaffected patients. We conclude that HPE is an underdiagnosed phenomenon with primary involvement of the lungs, where secondary vascular changes are common. Additional studies may be needed to clarify risks and to identify preventative strategies for this iatrogenic complication of catheterizations and “minimally invasive” endovascular techniques.

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Autopsy demonstration of intramyocardial polymer gel emboli associated with a giant-cell reaction following cardiac catheterization: a case report

Cited by 31 publications

References 3 publications

Distal Embolization of Hydrophilic-Coating Material From Coronary Guidewires After Percutaneous Coronary Interventions

Distal Embolization of Hydrophilic-Coating Material From Coronary Guidewires After Percutaneous Coronary Interventions

Non-ischemic cerebral enhancing lesions secondary to endovascular aneurysm therapy: nickel allergy or foreign body reaction? Case series and review of the literature

Hydrophilic polymer embolism and associated vasculopathy of the lung: prevalence in a retrospective autopsy study

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