Pathologic Identification of Foreign Materials Associated with Cardiovascular Interventional Devices.
Elena R Ladich, Naima Carter-Monroe, Frank Kolodgie, Michelle Olson, Renu Virmani. CVPath Institute Inc, Gaithersburg
Background: Foreign materials associated with cardiovascular interventions include metals and wires, polymers for drug delivery, hydrogel coatings, plastic sheaths, and gauze; these have a possibility of distal embolization. Herein we describe some pathologic consequences associated with dislodgement and embolization of foreign materials used routinely in cardiovascular technologies.
Design: Our laboratory processes a large numbers of cardiovascular devices in various locations such as coronary arteries, peripheral vasculature, myocardium and other organs. Multiple sections of distal myocardium and organs were taken at the time of explantation to determine the presence or absence of emboli. Scanning electron microscopy and spectroscopy were performed in cases where foreign materials were identified to determine the composition of the material.
Results: A variety of foreign materials were identified in vascular, myocardial and organ sections following cardiac interventions. 1) Basophilic non-polarizable material morphologically consistent with hydrogel has been identified in several anatomic locations. Fragments of hydrogel were seen in small intramyocardial arteries following coronary stenting. In addition, hydrogel fragments were identified within the cavernous sinus of a carotid artery with a cerebral coil implant. Another case showed hydrogel fragments and Teflon coating in the left atrium surrounding a trans-septal puncture site. 2) Plastic fragments, presumably originating from the introducer sheath, were identified in myocardial sections associated with granulomatous inflammation. 3) Dislodged fragments of stent polymer were found adjacent to struts eliciting a granulomatous reaction as well as within distal myocardium. 4) Myocardial sections showed small polarizable fragments consistent with cotton fibers surrounded by granulomatous inflammation and giant cells.
Conclusions: Coronary and peripheral arterial interventions produce morphologic changes that are influenced by the procedure or device used. In approaching such cases, the pathologist must be knowledgeable about the devices and delivery systems used and the potential for foreign materials associated with these technologies to embolize. Special studies such as scanning electron microscopy and spectroscopy may be required to elucidate the composition of these foreign materials.
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 40, Wednesday Afternoon