Abstract
Objectives
A foreign body granuloma after an endovascular intervention is a rare complication.
Some cases of foreign body granulomas, especially after coil embolization, have been
reported. However, only four cases of foreign body granulomas after mechanical thrombectomy
(MT) have previously been reported. The current study reports two cases of post-MT
foreign body granulomas, including a biopsy-proven case.
Material and Methods
Case 1: A 73-year-old woman presented with complete occlusion of the right middle cerebral
artery. Cerebral angiography and MT were successfully performed with improvement in
clinical symptoms. Left hemiparesis and a disturbance in attention appeared after
discharge and progressed slowly. She was re-admitted to our hospital 120 days after
cerebral infarction owing to foreign body granulomas diagnosed on biopsy. Case 2: A 78-year-old man presented with occlusion of the left cervical internal carotid
artery and the left middle cerebral artery. Cerebral angiography, percutaneous transluminal
angioplasty, and MT were successfully performed. On the 34th day, he experienced progressive
consciousness disorder because of foreign body granulomas. Both cases were successfully
treated with steroid therapy.
Results
MRI after steroid treatment showed the disappearance of most nodular lesions and improvement
of the encephalopathy.
Conclusions
The cause of the granuloma may be an allergic reaction to the hydrophilic polymers
that peel from endovascular devices. Steroid therapy is an effective treatment; therefore,
neurologists should consider this complication when neurological symptoms or signs
on image appears or worsens. A reliable diagnosis is important for prompt treatment.
Keywords
Abbreviations:
ACA (anterior cerebral artery), CSF (cerebrospinal fluid), DPHL (delayed post-hypoxic leukoencephalopathy), DWI (diffusion-weighted imaging), FLAIR (fluid-attenuated inversion recovery), MCA (middle cerebral artery), MRA (magnetic resonance angiography), MRI (magnetic resonance imaging), MT (mechanical thrombectomy), TICI (thrombolysis in cerebral infarction)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 12, 2023
Accepted:
January 9,
2023
Received in revised form:
January 6,
2023
Received:
November 4,
2022
Footnotes
Work was carried out at Yokohama Brain and Spine Center.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.106990
Copyright
© 2023 Elsevier Inc. All rights reserved.
