Cerebral foreign body reaction after carotid aneurysm stenting.
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.
Department of Radiology, Østfold Hospital Trust HF, Norway Department of Neurology, Oslo University Hospital, Rikshospitalet, Norway.
Anastasia Orlova
AO
Lorentzen
Department of Neuroradiology, Oslo University Hospital, Rikshospitalet, Norway.
Terje
T
Nome
Department of Neuroradiology, Oslo University Hospital, Rikshospitalet, Norway.
Søren Jacob
SJ
Bakke
Department of Pathology, Rigshospitalet, Copenhagen, Denmark.
David
D
Scheie
Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Norway.
Vidar
V
Stenset
Department of Neurology, Oslo University Hospital, Rikshospitalet, Norway anhaam@ous-hf.no.
Anne Hege
AH
Aamodt
D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D001929:Brain Edema / Q000209:etiology* / Q000473:pathology; D002340:Carotid Artery Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D005549:Foreign-Body Reaction / Q000209:etiology* / Q000473:pathology; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome
Cerebral aneurysm; cerebrovascular disease; endovascular; flow diverter stent; foreign body reaction