Dr Kieran Muir1, DR KARTHIK KUMAR
1Central Coast Local Health District, Gosford, Australia
Background
Polymer coating of intravascular devices have been increasingly used since the 1980s to reduce friction and thus arterial spasm and pain during vascular access. There have been reports of polymer coating shearing off during access and embolising to organs including lungs, brain, feet, heart, skin, liver and kidney. A post-mortem study observed distal embolization of polymer coating in 10% of percutaneous coronary interventions. This is likely an under observed clinical event.
Case Report
Mr AW presented following an out-of-hospital cardiac arrest for which he was successfully resuscitated and diagnosed to have an ST-elevation myocardial infarction. He underwent successful percutaneous coronary intervention to the left anterior descending artery. His echocardiogram demonstrated a reduced ejection fraction and he was treated with optimal medical therapy.
Post angiography and discharge from hospital, his renal function deteriorated from a baseline creatinine of 90umol/L to 200umol/L over a ten-month period with associated proteinuria (albumin: creatinine ratio 142mg/mmol) and microscopic haematuria. Imaging of the kidneys was unremarkable. He underwent a renal biopsy.
His renal biopsy showed microvascular embolisation with hyaline-like material. Occasionally this material is extruding out of the arteriolar walls into the interstitium causing his interstitial inflammation. His renal function began to improve following his biopsy and 16 months post angiography has returned to normal.
Conclusions
This is the first case report that demonstrates microvascular embolization of a polymer coating following coronary angiography into the renal vasculature with associated interstitial inflammation.
Biography:
Bio to come