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Foreign Body Emboli following Cerebrovascular Interventions: Clinical, Radiographic, and Histopathologic Features.

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This summary is machine-generated.

Foreign material from catheter coatings can cause emboli, leading to brain lesions after neurointerventional procedures. Treatment with corticosteroids may improve outcomes, but the course can be variable.

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Area of Science:

  • Neurointerventional Radiology
  • Neuropathology

Background:

  • Foreign material emboli are a known complication of catheterizations.
  • Catheter coatings are frequently implicated in these embolic events.
  • Recent neurointerventional procedures, particularly those using flow-diversion devices for cerebral aneurysms, have seen a resurgence of this phenomenon.

Purpose of the Study:

  • To investigate the etiology and clinical presentation of foreign material emboli in patients undergoing neurointerventional procedures.
  • To characterize the histopathological findings associated with these embolic events.
  • To evaluate the treatment response and clinical course.

Main Methods:

  • Case series analysis of patients who developed enhancing lesions post-catheterization.
  • Review of conventional angiography, laboratory work-up (CSF analysis), and brain biopsy findings.
  • Assessment of clinical outcomes following corticosteroid administration.

Main Results:

  • Five patients developed multiple subcentimeter enhancing lesions in vascular territories of treated aneurysms after procedures involving Pipeline embolization or stent-supported coiling.
  • Brain biopsies revealed granulomatous angiitis encasing foreign material consistent with polyvinylpyrrolidone catheter coating.
  • Corticosteroid therapy generally led to clinical improvement, though radiographic and clinical courses were heterogeneous.

Conclusions:

  • Foreign material from catheter coatings, specifically polyvinylpyrrolidone, can cause granulomatous angiitis and embolic lesions in the brain.
  • These complications are associated with advanced neurointerventional techniques, including flow-diversion devices.
  • While corticosteroids can be effective, the clinical and radiographic outcomes can be variable.