Cerebral foreign body granulomas after mechanical thrombectomy: Two case reports and a review of the literature

Ishikawa, Shota; Kudo, Yosuke; Miyake, Shigeta; Akimoto, Taisuke; Chiba, Sawako; Saruta, Wakiko; Mochizuki, Takahiro; Shimizu, Satoru; Amano, Yu; Yamamoto, Ryoo; Amari, Kazumitsu; Koyano, Shigeru; Johkura, Ken; Yamamoto, Tetsuya; Nakai, Yasunobu

doi:10.1016/j.jstrokecerebrovasdis.2023.106990

Cited by 3 publications

(10 citation statements)

References 22 publications

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“…Excess friction between devices and prolonged procedure times are factors resulting in the separation of device coatings [1,2]. In this patient, no di culty was noted in accessing the right iliac artery aneurysm, and the procedure was completed without any complications.…”

Section: Discussionmentioning

confidence: 84%

“…In this case, other potential exogenous materials include hydrophilic polymers and coils. First, hydrophilic polymers used in devices may cause foreign body embolisms, and foreign bodies may induce delayed granulomatous responses [1,2]. Since our patient also underwent endovascular intervention using a hydrophilic-coated device, it is possible that foreign body reaction to hydrophilic polymer may have caused the foreign body granuloma.…”

Section: Discussionmentioning

confidence: 97%

“…Foreign body granuloma has been reported as a rare complication of endovascular treatment, often associated with hydrophilic polymers used as coatings on neuro-endovascular intervention devices can cause granulomatous in ammation [1,2]. Additionally, foreign body granulomas due to embolic materials such as NBCA [3][4][5], Onyx [6, 7], and gelatin sponges [8] have been reported previously.…”

Section: Discussionmentioning

confidence: 99%

“…Foreign body granulomas have recently emerged as a rare complication of endovascular treatment [1][2][3][4][5][6][7][8][9][10][11][12][13], with most of them occurring in the brain or cutaneous vascular tissues. These granulomas pose diagnostic challenges, particularly when presenting as mass formation on imaging, often mimicking neoplasms.…”

Section: Introductionmentioning

confidence: 99%

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Foreign body granuloma after embolization of internal iliac artery using N-butyl-2-cyanoacrylate: a case report

Fumimoto,

Kohno,

Oka

et al. 2024

Preprint

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Background Foreign body granulomas following endovascular treatment rarely occur in the brain or cutaneous vascular tissues. To the best of our knowledge, no study to date has reported on foreign body granulomas in the abdomen after injection of N-butyl-2-cyanoacrylate (NBCA) into the large- and medium-size arteries. This study reports a case of foreign body granuloma that appeared 12 months after embolization of a right internal iliac artery aneurysm using NBCA, which posed challenges in differentiation from malignant tumors and aneurysm rupture.Case presentation A 77-year-old man underwent embolization of a right internal iliac artery aneurysm and open surgical repair of an abdominal aortic aneurysm. Contrast-enhanced computed tomography (CT) performed 12 months postoperatively revealed a right-sided retroperitoneal mass surrounding the iliopsoas muscle. The mass contained multiple, small, hyperdense areas, suggesting migration of the NBCA-lipiodol mixture casts from the embolized right iliac artery aneurysm. The differential diagnosis included foreign body granuloma, lymphoma, and sarcoma. Biopsy of the lesion revealed a granuloma with various stages of inflammation, no hemosiderin deposition, multinucleated giant cells, and foam cells containing fat, and was diagnosed with a foreign body granuloma. Special staining for microorganisms revealed no findings suggestive of infection. As the patient was asymptomatic, no treatment was administered. Contrast-enhanced CT at 24 months postoperatively showed shrinkage of the mass, with no change in size noted at 48 months postoperatively.Conclusions This report highlights a foreign body granuloma that mimicked malignant tumors and aneurysm rupture after embolization of a right internal iliac artery aneurysm. Extravascular migration of the NBCA-lipiodol mixture casts likely contributed to granuloma formation. Interventional radiologists should consider foreign body granulomas after embolization using NBCA into the large- and medium-size arteries.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Foreign body granuloma after embolization of internal iliac artery using N-butyl-2-cyanoacrylate: a case report

Fumimoto,

Kohno,

Oka

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…Foreign body granulomas have recently emerged as a rare complication of endovascular treatment [1][2][3][4][5][6][7][8][9][10][11][12][13], mostly reported in the brain or cutaneous vascular tissues. These granulomas pose diagnostic challenges, particularly when presenting as mass formation on imaging, often mimicking neoplasms.…”

Section: Introductionmentioning

confidence: 99%

Foreign Body Granuloma After Embolization of Internal Iliac Artery Aneurysm Using N-Butyl-2-Cyanoacrylate: A Case Report

Fumimoto,

Kohno,

Oka

et al. 2024

Cureus

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Foreign body granulomas following endovascular treatment are rare complications and are mostly reported in the brain or cutaneous vascular tissues. To the best of our knowledge, no study to date has reported on foreign body granulomas in the abdomen after injection of N-butyl-2-cyanoacrylate (NBCA)-lipiodol mixture into the abdominal arteries. This study reports a case of foreign body granuloma that appeared 12 months after the embolization of a right internal iliac artery aneurysm using an NBCA-lipiodol mixture, which posed challenges in differentiation from malignant tumors. We present a 77-year-old man who underwent embolization of a right internal iliac artery aneurysm and open surgical repair of an abdominal aortic aneurysm. A contrast-enhanced CT performed 12 months postoperatively revealed a right-sided retroperitoneal mass surrounding the iliopsoas muscle. The mass contained multiple, small, hyperdense areas, suggesting the migration of the NBCA-lipiodol mixture casts from the embolized right internal iliac artery aneurysm. The differential diagnosis included foreign body granuloma, lymphoma, and sarcoma. A biopsy of the lesion revealed a granuloma with various stages of inflammation, no hemosiderin deposition, multinucleated giant cells, and foam cells containing fat, and was diagnosed with a foreign body granuloma. Special staining for microorganisms revealed no findings suggestive of infection. Because the patient was asymptomatic, no treatment was administered. Contrast-enhanced CT at 24 months postoperatively showed shrinkage of the mass, with no change in size noted at 48 months postoperatively. This report highlights a foreign body granuloma that mimicked malignant tumors. Extravascular migration of the NBCA-lipiodol mixture casts likely contributed to granuloma formation. Radiologists should consider foreign body granulomas after embolization using NBCA into the abdominal arteries.

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Non-ischemic cerebral enhancing (NICE) lesions after flow diversion for intracranial aneurysms: a multicenter study

Richter,

Möhlenbruch,

Vollherbst

et al. 2024

J NeuroIntervent Surg

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BackgroundNon-ischemic cerebral enhancing (NICE) lesions have been reported as a rare complication of various neuroendovascular procedures, but information on their incidence after flow diversion is scant. It is unclear if specific devices or novel coating technologies may impact their occurrence.MethodsWe conducted a multicenter study on the incidence of NICE lesions after flow diverter (FD) implantation for cerebral aneurysm treatment.ResultsEight centers identified 15 patients and provided detailed data. The clinical presentation ranged from asymptomatic to hemiplegia and cognitive impairment. The mean time to diagnosis after treatment was 65.1±101.5 days. Five centers disclosed information on all of their 1201 FD procedures during the inclusion period (2015–2022), during which 12 patients were diagnosed with NICE lesions in these institutions—that is, an incidence of 1%. FD coatings did not increase the incidence (6/591 patients (1%) treated with surface-modified FD vs 6/610 patients (1%) treated with bare FD; P=1.00). Significantly increased rates of 3.7% (6 cases in 161 procedures; P<0.01) and 3.3% (5 cases in 153 procedures; P<0.01) were found with stents of two specific product lines. The use of one product line was associated with a significantly lower incidence (0 cases in 499 procedures (0%); P<0.01).ConclusionsNovel stent coatings are not associated with an increased incidence of NICE lesions. The incidence rate of 1% suggests that these lesions may occur more often after flow diversion than after other endovascular treatments. We found a concerning accumulation of NICE lesion cases when FDs from two product families were used.

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Cerebral foreign body granulomas after mechanical thrombectomy: Two case reports and a review of the literature

Cited by 3 publications

References 22 publications

Foreign body granuloma after embolization of internal iliac artery using N-butyl-2-cyanoacrylate: a case report

Foreign body granuloma after embolization of internal iliac artery using N-butyl-2-cyanoacrylate: a case report

Foreign Body Granuloma After Embolization of Internal Iliac Artery Aneurysm Using N-Butyl-2-Cyanoacrylate: A Case Report

Non-ischemic cerebral enhancing (NICE) lesions after flow diversion for intracranial aneurysms: a multicenter study

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