Case Report Myocardial hydrophilic polymer emboli following cardiac catheterization: a case report and literature review Lauren E. Rosen ⁎, Rohit I. Singh, Brett Mahon Department of Pathology, Rush University Medical Center, Chicago, IL 60612, USA abstract article info Article history: Received 31 December 2013 Received in revised form 27 January 2014 Accepted 28 January 2014 Keywords: Cardiac catheterization Hydrophilic polymer emboli Myocardial infarction Background: Intravascular polymer emboli have been reported in the skin, lungs, and brain following vascular procedures utilizing hydrophilic polymer coated devices. The Cook arterial introducer sheath was the first of these devices to be introduced, after which case reports followed documenting sterile inflammation at the sheath access site, characterized histologically by perivascular granulomas containing hydrophilic polymer. More recently, hydrophilic polymer emboli have been reported in the vessels of the lungs and brain in association with ischemia and infarct following vascular procedures using polymer coated devices. Methods: We report a case of intravascular myocardial emboli associated with acute myocardial infarction following cardiac catheterization. The patient was a 65-year-old man who received cardiac catheterization with placement of a bare metal stent following myocardial infarction. One month later, the patient presented with angina and died shortly after admission. Results: Autopsy revealed hemopericardium with rupture of the left ventricle through an aneurismal defect within the area of prior infarction. Microscopically, an area of acute infarction was present within the aneurismal defect. Numerous small and medium-sized vessels within the left ventricle were occluded by basophilic amorphous granular material with an inflammatory giant cell response. Conclusion: The emboli were most frequent in the area of acute infarction, suggesting that the emboli may have resulted in ischemia leading to the patient's death. This is the third documented case of intramyocardial polymer emboli following cardiac catheterization and the first case to our knowledge to document an association between intravascular myocardial polymer emboli and acute myocardial infarction. © 2014 Elsevier Inc. All rights reserved. 1. Introduction Intravascular polymer emboli have been reported in the skin, lungs, kidneys, and brain [1,2] following vascular procedures utilizing hydrophilic polymer-coated devices. We report a case of intravascular myocardial emboli associated with acute myocardial infarction following cardiac catheterization. This is the third documented case of intramyocardial polymer emboli following cardiac catheterization [1,3] and the first case to our knowledge to document an association between intravascular myocardial polymer emboli and acute myo- cardial infarction. 2. Clinical history The patient was a 65-year-old male with a history of hypertension who presented to the emergency department with acute coronary syndrome. A cardiac catheterization was performed and revealed one vessel disease with 90% stenosis of the circumflex coronary artery. A bare metal stent was placed in the proximal circumflex artery with the use of the following devices: 6F EBU launcher coronary guide wire, 0.014 in × 190-cm Abbott hi-torque balance middle weight universal guide wire, 2.9F Jovus eagle eye platinum catheter, and Sprinter legend RX balloon. The procedure was complicated by thrombus formation in the circumflex which was treated with thrombectomy and mechanical aspiration (Bayer fetch2 aspiration catheter). The patient was discharged in stable condition and was readmitted one month after the procedure for a syncopal episode. Shortly after admission, the patient suffered a cardiac arrest and expired. 3. Results Autopsy revealed hemopericardium with rupture of the left ventricle through a pseudoaneurysm present within an area of prior infarction (measuring 6.5×6.0 cm) of the left ventricular free wall, in the territory of the circumflex artery. A bare metal stent was in place in the proximal circumflex artery and was patent. Microscopically, the myocardium of the left ventricular free wall adjacent to the site of rupture showed acute infarction characterized by early coagulative necrosis (Fig. 1a). The acute infarct was similarly present within the distribution of the circumflex artery. Numerous small- and medium- Cardiovascular Pathology 23 (2014) 175–177 No funding was received in the conduct of this research or in the preparation of the manuscript. ⁎ Corresponding author. 1750 West Harrison Street, Suite 535, Chicago, IL 60612, USA. Tel.: +1 860 558 9409; fax: +1 312 942 4228. E-mail address: Lauren_E_Rosen@rush.edu (L.E. Rosen). 1054-8807/$ – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.carpath.2014.01.009 Contents lists available at ScienceDirect Cardiovascular Pathology