Foreign body reaction toward hydrophilic polymer at the site of endovascular procedure: A report of two cases

The use of flow diverting stents for wide based, intracranial aneurysms has become an invaluable treatment option. While intracranial hemorrhage and ischemic stroke from dislodged atherosclerotic emboli are common adverse events, the potential for delayed granulomatous inflammation from possible hydrophilic polymer emboli is rarely recognized. We present a unique case in which visible chipping of the pusher wire for stent placement was observed, followed by clinical and radiographic evidence suggestive of a delayed foreign body reaction to intracranial hydrophilic polymer emboli. A 55-year-old woman underwent placement of a Pipeline embolization device for a left-sided, broad-based aneurysm at the base of the internal carotid artery and posterior communicating artery. Two months later she developed right-sided focal neurological deficits. Imaging showed ipsilateral focal edema and enhancing lesions with contrast. Although not confirmed with biopsy and histopathology, clinical and radiographic evidence suggests that this patient probably experienced a delayed foreign body reaction to hydrophilic polymer emboli from compromised procedural equipment during flow diverting stent placement. Although previously described, this is the first instance to our knowledge in whichvisible chipping of the pusher wire was observed on a Pipeline embolization device.

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Cerebral foreign body reaction after carotid aneurysm stenting

Interventional Neuroradiology ◽

10.1177/1591019915609171 ◽

2015 ◽

Vol 22 (1) ◽

pp. 53-57 ◽

Cited By ~ 21

Author(s):

Anastasia Orlova Lorentzen ◽

Terje Nome ◽

Søren Jacob Bakke ◽

David Scheie ◽

Vidar Stenset ◽

...

Keyword(s):

Foreign Body ◽

Internal Carotid ◽

Foreign Body Reaction ◽

Artery Aneurysm ◽

Brain Biopsy ◽

Flow Diverter ◽

Left Internal Carotid Artery ◽

Hydrophilic Polymer ◽

Carotid Artery Aneurysm ◽

Internal Carotid Artery Aneurysm

Flow diverter stents are new important tools in the treatment of large, giant, or wide-necked aneurysms. Their delivery and positioning may be difficult due to vessel tortuosity. Common adverse events include intracranial hemorrhage and ischemic stroke, which usually occurs within the same day, or the next few days after the procedure. We present a case where we encountered an unusual intracerebral complication several months after endovascular treatment of a large left internal carotid artery aneurysm, and where brain biopsy revealed foreign body reaction to hydrophilic polymer fragments distally to the stent site. Although previously described, embolization of polymer material from intravascular equipment is rare. We could not identify any other biopsy verified case in the literature, with this particular presentation of intracerebral polymer embolization – a multifocal inflammation spread out through the white matter of one hemisphere without hemorrhage or ischemic changes.

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Foreign Body Reaction to Exogenous Pulmonary Surfactant in an Infant with Hydrops and Cardiomyopathy

Fetal and Pediatric Pathology ◽

10.3109/15513819609168663 ◽

1996 ◽

Vol 16 (1) ◽

pp. 83-88

Author(s):

Robert Bendon ◽

Jim Greenberg ◽

Sue Heffelfinger

Keyword(s):

Foreign Body ◽

Pulmonary Surfactant ◽

Foreign Body Reaction

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Delayed Cerebral Edema: Possible Association with an Inflammatory Foreign Body Reaction

Interdisciplinary Neurosurgery ◽

10.1016/j.inat.2021.101207 ◽

2021 ◽

pp. 101207

Author(s):

Sook Young Sim ◽

Chan-Young Choi

Keyword(s):

Foreign Body ◽

Cerebral Edema ◽

Foreign Body Reaction

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Granuloma Caused by Carbon Deposition in the Dermis

Case Reports in Dermatological Medicine ◽

10.1155/2014/686489 ◽

2014 ◽

Vol 2014 ◽

pp. 1-2

Author(s):

Rintaro Shibuya ◽

Yuichiro Endo ◽

Akihiro Fujisawa ◽

Miki Tanioka ◽

Yoshiki Miyachi

Keyword(s):

Computed Tomography ◽

Foreign Body ◽

Malignant Melanoma ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Foreign Body Reaction ◽

Carbon Deposition ◽

Case Reports ◽

Initial Injury ◽

Pencil Lead

Pencil core granuloma is characterized by a delayed foreign-body reaction against retained fragments of pencil lead. Previous case reports presented pencil core granuloma resembling malignant melanoma, haemangioma, or soft tissue sarcoma. We present a case of pencil core granuloma arising from the palm 25 years after the initial injury. The patient presented a bluish nodule that had been present over 25 years before. The nodule initially measured 5 mm in diameter. However, five years before presentation, it suddenly enlarged to the size of 30 mm during six months. Computed tomography (CT) of the lesion revealed a linear radiopaque structure of 8 mm long with a mass on its distal end. Surgical resection revealed a bluish muddy mass and pencil lead. Histological examination revealed degenerative tissue with calcification surrounded by massive amounts of black granular material in the middle and lower dermis.

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