Mehta Rashi I, Mehta Rupal I
Department of Radiology, State University of New York Upstate Medical University, Syracuse, NY 13210.
Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642; Center for Neural Development and Disease (CNDD), University of Rochester Medical Center, Rochester, NY 14642.
Hum Pathol. 2016 Jul;53:178-90. doi: 10.1016/j.humpath.2016.01.018. Epub 2016 Apr 9.
Polymer substances are commonly applied as surface coatings on endovascular catheters and vascular devices. Adverse effects related to their use have been reported, although the overall clinical significance and appropriate methods of detection of these complications have been unclear. In this analysis, we systematically reviewed clinical and diagnostic features in 32 patients (age, 36-87years; mean, 59years) in whom intracranial polymer reactions were documented following vascular interventions. Associated neuroradiologic and neuropathologic findings were variable and included cerebral vasculitis or vasculopathy (63%), abscess or granuloma formation (38%), ischemic infarcts (28%), parenchymal hematomas (28%), white matter change (25%), and/or chemical meningitis (22%). Location(s) of polymer reactions varied and included sites adjacent to and/or downstream from instrument insertion or implantation. Presenting clinical signs included focal neurologic deficits (41%), headache (22%), constitutional symptoms (19%), meningitis (16%), seizure and/or involuntary movements (9%), coma (6%), and syncope (3%). Adverse outcomes included stroke (31%), death (28%), delayed communicating hydrocephalus (9%), steroid dependency (9%), steroid complications (6%), and cerebral volume loss (3%). In some cases, these complications necessitated increased cost and length of medical care. In this review, we highlight the diverse features of polymer-induced reactions involving the central nervous system and summarize distinct diagnostic patterns that may enable earlier premortem detection of these lesions in the postprocedural clinical setting. Further work in this area is necessary to identify additional etiologic, preventative and therapeutic strategies. These data have potentially broad implications pertaining to the safety, efficacy, standards of use, storage, manufacturing, and regulation of new and emerging vascular devices and polymer nanotechnologies.
聚合物物质通常被用作血管内导管和血管装置的表面涂层。尽管这些并发症的总体临床意义及合适的检测方法尚不清楚，但与它们使用相关的不良反应已有报道。在本分析中，我们系统回顾了32例（年龄36 - 87岁，平均59岁）血管介入后记录有颅内聚合物反应患者的临床和诊断特征。相关的神经放射学和神经病理学表现各异，包括脑血管炎或血管病变（63%）、脓肿或肉芽肿形成（38%）、缺血性梗死（28%）、实质血肿（28%）、白质改变（25%）和/或化学性脑膜炎（22%）。聚合物反应的部位各不相同，包括器械插入或植入部位附近和/或下游部位。呈现的临床体征包括局灶性神经功能缺损（41%）、头痛（22%）、全身症状（19%）、脑膜炎（16%）、癫痫和/或不自主运动（9%）、昏迷（6%）和晕厥（3%）。不良后果包括中风（31%）、死亡（28%）、延迟性交通性脑积水（9%）、类固醇依赖（9%）、类固醇并发症（6%）和脑容量减少（3%）。在某些情况下，这些并发症导致医疗费用增加和医疗时间延长。在本综述中，我们强调了涉及中枢神经系统的聚合物诱导反应的多样特征，并总结了不同的诊断模式，这些模式可能有助于在术后临床环境中更早地进行生前这些病变的检测。该领域需要进一步开展工作以确定其他病因、预防和治疗策略。这些数据对于新兴血管装置和聚合物纳米技术的安全性、有效性、使用标准、储存、制造和监管可能具有广泛的意义。
