Fatal Intracerebral Hemorrhage After Pipeline Embolization of Aneurysm: Histopathological Analysis
Delayed ipsilateral intraparenchymal hemorrhage following aneurysm treatment with the Pipeline Embolization Device has been observed in multiple studies without a clear etiology. This important study demonstrates convincing histopathological evidence of foreign material occluding small vessels within the hemorrhagic area in 3 such patients following uneventful Pipeline treatment of supraclinoid aneurysms. FTIR spectroscopy showed the foreign material to be polyvinylpyrrolidone (PVP), a substance commonly used in the hydrophilic coatings of interventional catheters and wires. This material was identical to the coating of a guide sheath common to all 3 procedures, and two videos illustrate the potential hazard of intraprocedural device-related foreign body emboli.