Abstract
Background/Objectives Inflammatory reactions to catheter polymer coating emboli are a rare complication of endovascular procedures with potentially devastating consequences. Prompt recognition and early commencement of immunosuppressive therapy is key, though optimal treatment guidelines are lacking.
Methods Case report.
Results A 36-year-old woman was managed for a left middle cerebral artery stroke with endovascular clot retrieval (ECR) with stent retriever and primary aspiration using REBAR-18 and Phenom Plus (Medtronic) and SL-10 (Stryker) catheters. Her initial aphasia resolved but she represented 3 weeks later with a severe persistent headache. Her medical history included psoriatic arthritis on methotrexate and leflunomide, type 1 diabetes mellitus, atopic disease and migraine. Interval MRI scans demonstrated multiple new nodular and linear foci of enhancement in the left hemisphere. CSF examination revealed a neutrophilic pleocytosis and normal protein. Brain biopsy demonstrated a focus of neutrophilic microabscess with surrounding reactive brain tissue and isolated multinucleated giant cells containing foreign material. She received pulsed intravenous methylprednisolone, intravenous antibiotics despite negative cultures and remains on oral prednisolone and methotrexate. Her headache resolved. Complicating further treatment decisions are an indeterminate tuberculosis result and flaring arthritis.
Conclusion/Discussion This case adds to the limited literature on similar foreign body reactions. Of note is that this complication occurred in a patient already on immunosuppressant medication and her neutrophilic CSF pleocytosis which has not been reported previously. While this outcome remains a rare complication of ECR, our case illustrates the need for ongoing awareness around such complications and more experience to guide optimal management.
