Table 3.
Summary of diagnosis, management and prevention of intracranial polymer-induced reactions
| Time of symptom onset: |
| Acute, subacute, or delayed postprocedure period(s) |
| Delayed ischemic or hemorrhagic infarcts in downstream treated vascular territories are suggestive |
| On postprocedure imaging, delayed enhancing inflammatory reactions in downstream treated vascular territories are highly suggestive, especially if persistent |
| Neuroradiologic or neuropathologic presentation(s): |
| Inflammatory reactions |
| Sterile perianeurysmal inflammation, sterile meningitis (ie, chemical meningitis), hydrocephalus |
| Sterile foreign body giant cell reaction, sterile granulomas (persistent/progressive), sterile abscesses |
| Embolic phenomena |
| Ischemic or hemorrhagic parenchymal infarcts |
| White matter changes |
| Arterial pathologies |
| Arterial obliteration, thrombosis, vasculitis, perivascular inflammation/rarefaction/hemosiderin, fibrinoid vascular necrosis, fibrin thrombi, luminal fibrosis, internal elastic lamina disruption |
| Supportive laboratory findings: |
| CSF: ↑ WBC, protein |
| Microbiology: cultures negative |
| Serum: ↑ WBC, ESR, CRP, p-ANCA, PT, PTT, D-dimer, FSP; ↓ fibrinogen |
| Identification of polymer on tissue sample: |
| H&E appearance: nonrefractile; nonpolarizable; predominantly basophilic, granular, and lamellated/ amorphous foreign body |
| Ancillary: Trichrome (blue), Congo red & mucicarmine (red) Spectroscopy: FTIR/Raman to identify polymer composition |
| Therapeutic options: |
| Steroids or immunosuppressives for inflammation, if indicated Surgical resection of persistent inflammatory lesion(s), if indicated Ventriculoperitoneal shunt for chemical meningitis, if indicated |
| Antiepileptics for seizure, if indicated |
| Antiplatelet therapy, if indicated |
| Supportive care |
| Preventative measures: |
| Avoidance of tight–fitting sheath/catheter/microcatheter /guidewire combinations |
| Use of dual groin punctures rather than triaxial/quadraxial or tight-fitting device combinations |
| Microcatheter lumen aspiration to reduce polymer microemboli |
| Avoidance of rapid withdrawal of guide wires and catheters |
| Discontinued use of damaged or deformed device(s) |
| Proper usage and storage of device(s) |
Abbreviation: FTIR, Fourier transform infrared.