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Mehta RI, Mehta RI. Hydrophilic Polymer Embolism: Implications for Manufacturing, Regulation, and Postmarket Surveillance of Coated Intravascular Medical Devices. J Patient Saf 2021; 17:e1069-e1079. [PMID: 29557931 PMCID: PMC6146079 DOI: 10.1097/pts.0000000000000473] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
ABSTRACT Hydrophilic polymers are ubiquitously applied as surface coatings on catheters and intravascular medical technologies. Recent clinical literature has heightened awareness on the complication of hydrophilic polymer embolism, the phenomenon wherein polymer coating layers separate from catheter and device surfaces, and may be affiliated with a range of unanticipated adverse reactions. Significant system barriers have limited and delayed reporting on this iatrogenic complication, the full effects of which remain underrecognized by healthcare providers and manufacturers of various branded devices. In 2015, the United States Food and Drug Administration acknowledged rising clinical concerns and stated that the agency would work with stakeholders to further evaluate gaps that exist in current national and international device standards for coated intravascular medical technologies. The present article reviews current knowledge on this complication as well as factors that played a role in delaying detection and dissemination of information and new knowledge once hazards and clinical risks were identified. Furthermore, organ-specific effects and adverse reaction patterns are summarized, along with implications for device manufacturing, safety assurance, and regulation. Qualitative and quantitative particulate testing are needed to optimize coated intravascular device technologies. Moreover, general enhanced processes for medical device surveillance are required for timely adverse event management and to ensure patient safety.
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Affiliation(s)
| | - Rupal I. Mehta
- University of Rochester Department of Pathology and Laboratory Medicine
- Department of Neuroscience
- Center for Neurotherapeutics Discovery (CND)
- Center for Translational Neuromedicine (CTN)
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Shah N, Javeed M, Patel N, Rodriguez-Waitkus P, Chen WS. Foreign body reaction toward hydrophilic polymer at the site of endovascular procedure: A report of two cases. J Cutan Pathol 2021; 48:781-784. [PMID: 33474744 DOI: 10.1111/cup.13966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/17/2020] [Accepted: 12/29/2020] [Indexed: 11/28/2022]
Abstract
Hydrophilic polymer-coated devices have been increasingly utilized for various endovascular procedures, however not been without adverse effects. We report two cases of subacute cutaneous lesions on the neck encountered in our dermatology clinic. Histopathologic findings were significant for a nodular aggregate of epithelioid histiocytes and lymphocytes with numerous foreign body giant cells in the dermis. The granulomatous infiltrate was associated with an amorphous basophilic non-polarizable material. Further chart review reveals both patients receiving a central venous procedure in the past, thus attributing the hydrophilic polymers as the likely source of the foreign material found at the insertion site. Our cases contrast to the more commonly reported distal embolization by these hydrophilic polymer layers. We suspect the incidence of retained hydrophilic polymer at the site of prior endovascular procedures may be underreported in the literature with the more inconspicuous presentations. Therefore, retained foreign material should be considered by both treating physicians and dermatopathologists in presenting cases of lesions that occur at common sites of endovascular procedures.
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Affiliation(s)
- Nirav Shah
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Masi Javeed
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Nishit Patel
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, Florida, USA
| | - Paul Rodriguez-Waitkus
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, Florida, USA
| | - Wei-Shen Chen
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, Florida, USA
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Chopra AM, Mehta M, Bismuth J, Shapiro M, Fishbein MC, Bridges AG, Vinters HV. Polymer coating embolism from intravascular medical devices — a clinical literature review. Cardiovasc Pathol 2017; 30:45-54. [DOI: 10.1016/j.carpath.2017.06.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/05/2017] [Accepted: 06/16/2017] [Indexed: 11/30/2022] Open
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Shotar E, Law-Ye B, Baronnet-Chauvet F, Zeidan S, Psimaras D, Bielle F, Pecquet C, Navarro S, Rosso C, Cohen F, Chiras J, Di Maria F, Sourour N, Clarençon F. Non-ischemic cerebral enhancing lesions secondary to endovascular aneurysm therapy: nickel allergy or foreign body reaction? Case series and review of the literature. Neuroradiology 2016; 58:877-85. [DOI: 10.1007/s00234-016-1699-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/10/2016] [Indexed: 12/01/2022]
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Dawson EA, Rathore S, Cable NT, Wright DJ, Morris JL, Green DJ. Impact of Introducer Sheath Coating on Endothelial Function in Humans After Transradial Coronary Procedures. Circ Cardiovasc Interv 2010; 3:148-56. [DOI: 10.1161/circinterventions.109.912022] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background—
The aim of this study was to compare the impact of transradial catheterization with hydrophilic-coated catheter sheaths versus uncoated sheaths on NO-mediated endothelial-dependent and -independent vasodilator function.
Methods and Results—
Thirty-five subjects undergoing transradial catheterization were recruited and assessed before and the day after catheterization. A subgroup was also assessed 3 to 4 months after catheterization. Subjects received hydrophilic-coated sheaths (n=15) or uncoated sheaths (n=20). Radial artery flow-mediated dilatation and endothelium- and NO-dependent arterial dilatation were assessed within the region of sheath placement. Glyceryl trinitrate endothelium-independent NO-mediated function was also assessed. The noncatheterized arm provided an internal control. Flow-mediated dilatation in the catheterized arm decreased from 10.3�3.8% to 5.3�3.3% and 8.1�2.4% to 5.2�3.7% in the coated and uncoated groups, respectively (
P
<0.01). These values returned toward baseline levels ≈3 months later (coated, 6.4�1.4%; uncoated, 9.4�4.1%;
P
<0.05) versus postprocedure. Glyceryl trinitrate decreased from 14.8�7.2% to 9.5�4.1% (
P
<0.05) in the coated group and from 12.2�4.6% to 7.5�4.2% (
P
<0.01) in the uncoated group. Values returned to baseline at ≈3 months (coated, 16.6�5.6%; uncoated, 12.1�3.9%;
P
<0.05). There was no difference in the magnitude of decrease in flow-mediated dilatation or glyceryl trinitrate between coated and uncoated groups. No changes in function occurred in the noncatheterized arm.
Conclusions—
Placement of a catheter sheath inside the radial artery disrupts vasodilator function, which recovers after 3 months. No differences were evident between hydrophilic-coated and uncoated sheaths.
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Affiliation(s)
- Ellen A. Dawson
- From the Research Institute for Sport and Exercise Sciences (E.A.D., N.T.C., D.J.G.), Liverpool John Moores University, and Liverpool Heart and Chest Hospital (S.R., D.J.W., J.L.M.), Liverpool, England, and School of Sport Science, Exercise and Health (D.J.G.), University of Western Australia, Western Australia, Australia
| | - Sudhir Rathore
- From the Research Institute for Sport and Exercise Sciences (E.A.D., N.T.C., D.J.G.), Liverpool John Moores University, and Liverpool Heart and Chest Hospital (S.R., D.J.W., J.L.M.), Liverpool, England, and School of Sport Science, Exercise and Health (D.J.G.), University of Western Australia, Western Australia, Australia
| | - N. Timothy Cable
- From the Research Institute for Sport and Exercise Sciences (E.A.D., N.T.C., D.J.G.), Liverpool John Moores University, and Liverpool Heart and Chest Hospital (S.R., D.J.W., J.L.M.), Liverpool, England, and School of Sport Science, Exercise and Health (D.J.G.), University of Western Australia, Western Australia, Australia
| | - D. Jay Wright
- From the Research Institute for Sport and Exercise Sciences (E.A.D., N.T.C., D.J.G.), Liverpool John Moores University, and Liverpool Heart and Chest Hospital (S.R., D.J.W., J.L.M.), Liverpool, England, and School of Sport Science, Exercise and Health (D.J.G.), University of Western Australia, Western Australia, Australia
| | - John L. Morris
- From the Research Institute for Sport and Exercise Sciences (E.A.D., N.T.C., D.J.G.), Liverpool John Moores University, and Liverpool Heart and Chest Hospital (S.R., D.J.W., J.L.M.), Liverpool, England, and School of Sport Science, Exercise and Health (D.J.G.), University of Western Australia, Western Australia, Australia
| | - Daniel J. Green
- From the Research Institute for Sport and Exercise Sciences (E.A.D., N.T.C., D.J.G.), Liverpool John Moores University, and Liverpool Heart and Chest Hospital (S.R., D.J.W., J.L.M.), Liverpool, England, and School of Sport Science, Exercise and Health (D.J.G.), University of Western Australia, Western Australia, Australia
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