Hydrophilic Polymer Embolism: An Underappreciated Complication of Endovascular Procedures that Physicians Should be Aware Of

Rajasekharan Pillai VN, Mutter M. Synthetic hydrophilic polymers. Naturwissenschaften. 1981;68:558–66.

Article  Google Scholar 

Mehta RI, Mehta RI. Hydrophilic polymer embolism: an update for physicians. Am J Med. 2017;130:e287–90.

Article  PubMed  PubMed Central  Google Scholar 

Mehta RI, Mehta RI. Hydrophilic polymer embolism: implications for manufacturing, regulation, and postmarket surveillance of coated intravascular medical devices. J Patient Saf. 2021;17:e1069–79.

Article  PubMed  PubMed Central  Google Scholar 

Chopra AM, Rapkiewicz A, Daggubati R, Sequeira A, Hu YC, Bhatt DL, et al. Analysis: intravascular devices with a higher risk of polymer emboli: the need for particulate generation testing. Biomed Instrum Technol. 2020;54:37–43.

Article  PubMed  Google Scholar 

Chopra AM, Mehta M, Bismuth J, Shapiro M, Fishbein MC, Bridges AG, et al. Polymer coating embolism from intravascular medical devices - a clinical literature review. Cardiovasc Pathol. 2017;30:45–54.

Article  CAS  PubMed  Google Scholar 

Stanley JRL, Tzafriri AR, Regan K, LaRochelle A, Wong G, Zani BG, et al. Particulates from hydrophilic-coated guiding sheaths embolise to the brain. EuroIntervention. 2016;11:1435–41.

Article  PubMed  Google Scholar 

Mordhorst A, Yang GK, Reitsma N, Chen JC, Zhang BY, Suri S, et al. Evaluation of hydrophilic polymer embolization from endovascular sheath devices in an in vitro perfusion system. JVS Vasc Sci. 2023;4: 100127.

Article  PubMed  PubMed Central  Google Scholar 

Dahl RH, Larsen RW, Thormann E, Benndorf G. Polytetrafluoroethylene coating fragments during neuroendovascular therapy: An analysis of two damaged microguidewires. Interv Neuroradiol. 2022;28:16–21.

Article  PubMed  Google Scholar 

Dahl RH, Larsen RW, Thormann E, Benndorf G. Fragmentation of hydrophilic guidewire coatings during neuroendovascular therapy. Clin Neuroradiol. 2023;33:793–9.

Article  PubMed  Google Scholar 

Mehta RI, Mehta RI, Solis OE, Jahan R, Salamon N, Tobis JM, et al. Hydrophilic polymer emboli: an under-recognized iatrogenic cause of ischemia and infarct. Mod Pathol. 2010;23:921–30.

Article  PubMed  Google Scholar 

Mehta RI, Mehta RI, Fishbein MC, Solis OE, Jahan R, Salamon N, et al. Intravascular polymer material after coil embolization of a giant cerebral aneurysm. Hum Pathol. 2009;40:1803–7.

Article  PubMed  PubMed Central  Google Scholar 

Food and Drug Administration (2015) Lubricious Coating Separation from Intravascular Medical Devices: FDA Safety Communication. Center for Devices and Radiological Health; [Accessed 2024 Nov 26]. Available from: https://wayback.archive-it.org/7993/20170722215712/http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm473794.htm

Food and Drug Administration (2019) Intravascular Catheters, Wires, and Delivery Systems with Lubricious Coatings - Labeling Considerations. FDA; [Accessed 2025 Jan 8]. Available from: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/intravascular-catheters-wires-and-delivery-systems-lubricious-coatings-labeling-considerations

Mehta RI, Rai AT, Vos JA, Solis OE, Mehta RI. Intrathrombus polymer coating deposition: a pilot study of 91 patients undergoing endovascular therapy for acute large vessel stroke Part I: Histologic frequency. J Neurointerv Surg. 2019;11:1191–6.

Article  PubMed  PubMed Central  Google Scholar 

Miyaoka M, Hatanaka K, Nakamura N. Hydrophilic polymer in thrombus specimens obtained during thrombus aspiration in the setting of percutaneous interventions in Japan. Int J Surg Pathol. 2021;29:146–9.

Article  CAS  PubMed  Google Scholar 

Grundeken MJ, Li X, Kurpershoek CE, Kramer MC, Vink A, Piek JJ, et al. Distal embolization of hydrophilic-coating material from coronary guidewires after percutaneous coronary interventions. Circ Cardiovasc Interv. 2015;8: e001816.

Article  CAS  PubMed  Google Scholar 

Mehta RI, Mehta RI, Choi JM, Mukherjee A, Castellani RJ. Hydrophilic polymer embolism and associated vasculopathy of the lung: prevalence in a retrospective autopsy study. Hum Pathol. 2015;46:191–201.

Article  CAS  PubMed  Google Scholar 

Frerker C, Schlüter M, Sanchez OD, Reith S, Romero ME, Ladich E, et al. Cerebral protection during MitraClip implantation: initial experience at 2 centers. JACC Cardiovasc Interv. 2016;9:171–9.

Article  PubMed  Google Scholar 

Chavez JA, Chen W, Frankel WL, Arnold CA. Hydrophilic polymer-associated ischemic enterocolitis. Am J Surg Pathol. 2017;41:271–6.

Article  PubMed  Google Scholar 

Hickey TB, Honig A, Ostry AJ, Chew JB, Caldwell J, Seidman MA, et al. Iatrogenic embolization following cardiac intervention: postmortem analysis of 110 cases. Cardiovasc Pathol. 2019;40:12–8.

Article  PubMed  Google Scholar 

Miyaoka M, Hatanaka K, Uekusa T, Nakamura N. Clinicopathological features of hydrophilic polymer emboli in Japanese autopsy cases. APMIS. 2018;126:838–41.

Article  CAS  PubMed  Google Scholar 

Mizutani H, Nakajima M, Ueda M. Delayed cerebral complications associated with endovascular catheter coil embolization for pulmonary venous shunts mimicking cerebral inflammatory diseases. Heliyon. 2024;10: e33541.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Goodwill VS, Brandel MG, Steinberg JA, Beaumont TL, Hansen LA. Hydrophilic polymer embolism identified in brain tumor specimens following Wada testing: A report of 2 cases. Free Neuropathol. 2021;2:2–23.

Google Scholar 

Abdalkader M, Sathya A, Ma A, Cervantes-Arslanian AM, Chung DY, Barest G, et al. Hydrophilic polymer embolization following flow diversion of cerebral aneurysms. Neuroradiol J. 2021;34:363–9.

Article  PubMed  PubMed Central  Google Scholar 

Boyle T, Fernando SL, Steinfort B, Li J, Krause M, Harrington T, et al. Medical treatment of polymeric cerebral granulomatous reactions following endovascular procedures. J Neurointerv Surg. 2021;13:1032–6.

Article  PubMed  Google Scholar 

Fernandes PM, Moreton FC, Du Plessis J, Chandran S. Hydrophilic polymer embolization following coiling of intracranial aneurysm. Ann Neurol. 2021;89:842–3.

Article  PubMed  Google Scholar 

Kitamura T, Oishi H, Fujii T, Teranishi K, Yatomi K, Yamamoto M, et al. Delayed complications due to polymer coating embolism after endovascular treatment. NMC Case Rep J. 2020;7:5–10.

Article  PubMed  Google Scholar 

Geisbush TR, Marks MP, Heit JJ. Cerebral foreign body reaction due to hydrophilic polymer embolization following aneurysm treatment by pipeline flow diversion device. Interv Neuroradiol. 2019;25:447–53.

Article  PubMed  PubMed Central  Google Scholar 

Tikka J, Gardberg M, Rautio R, Lunetta P. Left cerebral hemisphere hydrophilic polymer embolism associated with endovascular WEB treatment of a ruptured aneurysm of the anterior cerebral artery. Leg Med (Tokyo). 2018;35:66–8.

Article  CAS  PubMed  Google Scholar 

Kuribara T, Haraguchi K, Ohtaki S, Shimizu T, Matsuura N, Ogane K, et al. Progressive edematous lesions in subacute phase after neuroendovascular therapy. Surg Neurol Int. 2018;9:173.

Article  PubMed  PubMed Central  Google Scholar 

Ansari SA, Anderson RR, Caron MJ, Shaibani A, Hurley MC, Jahromi BS, et al. Hydrophilic polymer embolic complication during diagnostic cerebral angiography presenting with delayed intracranial hemorrhage: case report and literature review. J Neurointerv Surg. 2019;11:80–3.

Article  PubMed  Google Scholar 

Daneshmand A, Krecke KN, Wijdicks EFM. Plastic in the Brain: Delayed Recognition of Progressive Unilateral Hemispheric Lesions. Neurocrit Care. 2019;31:222–4.

Article  PubMed  Google Scholar 

Mehta RI, Perrin RJ, Baldzizhar R, Mehta RI. Polymer coating embolism: cause of cerebral vasculopathy and death following congenital heart repair in two infants. J Neuropathol Exp Neurol. 2017;76:978–80.

Article  PubMed  PubMed Central  Google Scholar 

Meiers C, Abebe Y, Alberto NM, Riedinger J, Breker DA, Manchak M, et al. Cerebral granulomatous inflammation secondary to hydrophilic polymer embolization following thrombectomy. Am J Case Rep. 2017;18:507–11.

Article  PubMed  PubMed Central 

Comments (0)

No login
gif