E-008 A novel liquid embolic material using a hydrophilic polymer composite activated by the Ca2+ in the blood: angiographical evaluation using a rabbit model

Introduction: Liquid embolic material (LEM) plays an essential role in the treatment of hemorrhagic stroke caused by arteriovenous malformation or dural arteriovenous fistula. However, currently available non-adhesive LEMs has the problem of catheter entrapment, and also known to have a cytotoxic effect due to the organic solvents such as Dimethyl Sulfoxide (DMSO). The New Generation Liquid Embolic Material (NGLEM) is a clear liquid that immediately forms a solid hydrogel cast upon exposure to Ca2+ in the bloodstream, and organic solvents are not required (Figure1). The performance of this new liquid embolic material was evaluated using an in vivo experimental model using rabbit. Methods: Under general anesthesia, a renal artery of New Zealand rabbit (4.5-5.0kg) was catheterized under fluoroscopy using a microcatheter, and NGLEM was injected into the artery. Following factors were assessed; 1) the amount of LEM required for the complete occlusion, 2) injection speed, 3) duration of the injection, 4) radiopacity during the deployment and 5) incidence of catheter entrapment after the injection. Results: Five renal arteries in five rabbits were treated, and all arteries were completely occluded without technical complication. The injected materials immediately formed LEM cast in all vessels followed by the reflux over the microcatheter. All catheters were withdrawn without any sign of catheter entrapment. The NGLEM mixed with both iodine-based (3 animals) and tantalum based (2 animals) contrasts medium showed sufficient radiopacity under fluoroscopy. With the injection speed of 0.02ml/sec, the average volume required was 0.68ml. Average time for the complete occlusion was 237 seconds. No increased thrombogenicity or vasospasm near the treated lesion was observed during the procedure. Conclusions: NGLEM, which is a DMSO free, non-adhesive bio-polymer may be used as an embolic material for the treatment of hemorrhagic stroke caused by cerebrovascular diseases.

Download Full-text

Retrieval of a migrated N-butyl-2 cyanoacrylate cast using a snare-kit system during dural AVF embolization: A case report

Interventional Neuroradiology ◽

10.1177/1591019918775957 ◽

2018 ◽

Vol 24 (5) ◽

pp. 571-573

Author(s):

Ramy Ahmed ◽

Satomi Ide ◽

Hiro Kiyosue ◽

Shuichi Tanoue ◽

Shunro Matsumoto ◽

...

Keyword(s):

Case Report ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Endovascular Procedures ◽

Sigmoid Sinus ◽

Embolic Material ◽

Coagulation Profile ◽

Liquid Embolic

N-butyl-2 cyanoacrylate (NBCA) is a liquid embolic material that is widely used in various endovascular procedures because of its permanent and rapid vascular occluding effect regardless of the coagulation profile of the patient. However, NBCA migration to unintended vessels may result in serious complications. This report describes the retrieval of a migrated NBCA cast from the transverse-sigmoid sinus during dural arteriovenous fistula embolization using a transvenous snaring technique.

Download Full-text

Preoperative Embolization of Cerebellar Hemangioblastomas with a Liquid Embolic Material (NBCA) by the “Plug and Push” Technique

Journal of Neuroendovascular Therapy ◽

10.5797/jnet.oa.2018-0027 ◽

2018 ◽

Vol 12 (10) ◽

pp. 475-480

Author(s):

Nobuyuki Shimizu ◽

Jun Suenaga ◽

Hiromasa Abe ◽

Kagemitsu Nagao ◽

Yuta Arakaki ◽

...

Keyword(s):

Preoperative Embolization ◽

Embolic Material ◽

Liquid Embolic

Download Full-text

Management of direct carotid-cavernous sinus fistulas with the use of ethylene-vinyl alcohol (Onyx) only: preliminary results

Journal of Neurosurgery ◽

10.3171/2009.6.jns09440 ◽

2010 ◽

Vol 112 (3) ◽

pp. 595-602 ◽

Cited By ~ 28

Author(s):

Marco Zenteno ◽

Jorge Santos-Franco ◽

Vladimir Rodríguez-Parra ◽

Jorge Balderrama ◽

Yolanda Aburto-Murrieta ◽

...

Keyword(s):

Case Series ◽

Endovascular Techniques ◽

Embolic Material ◽

Ethylene Vinyl Alcohol ◽

Sole Agent ◽

Novel Approach ◽

Embolic Agents ◽

Liquid Embolic ◽

Carotid Cavernous Fistulas

Object So-called direct carotid-cavernous fistulas (CCFs) are commonly treated by detachable balloons or coils to occlude the shunt while sparing the carotid artery. Liquid embolic agents have been rarely used, and in particular, to the authors' knowledge, the use of Onyx as the sole agent has never been reported in an indexed publication. Methods The authors describe a case series of 5 patients with posttraumatic CCF in whom embolization with Onyx was prospectively used as the sole strategy of management. Results Complete occlusion was obtained at the end of the procedure in 4 cases, and the lesion in the remaining patient subsequently occluded at the 6-month follow-up evaluation. Conclusions As endovascular techniques for treatment of direct CCFs continue to evolve, this novel approach with Onyx as the sole embolic material seems promising in treating these lesions.

Download Full-text

Percutaneous Transfacial Direct Embolization of an Intraosseous Dural Arteriovenous Fistula

Operative Neurosurgery ◽

10.1227/neu.0000000000000213 ◽

2013 ◽

Vol 10 (1) ◽

pp. E178-E182 ◽

Cited By ~ 1

Author(s):

John D. Nerva ◽

Danial K. Hallam ◽

Basavaraj V. Ghodke

Keyword(s):

Arteriovenous Fistula ◽

Image Guidance ◽

Dural Arteriovenous Fistula ◽

Venous Congestion ◽

Embolic Material ◽

Ocular Symptoms ◽

Novel Approach ◽

Liquid Embolic ◽

Emissary Veins

Abstract BACKGROUND AND IMPORTANCE: An intraosseous dural arteriovenous fistula (DAVF) is a rare cerebrovascular disease. The fistulous connection occurs within intraosseous diploic or transosseous emissary veins causing dilated intraosseous vascular pouches. To the authors' knowledge, this report describes the first percutaneous transfacial direct embolization of an intraosseous DAVF. CLINICAL PRESENTATION: A man in his 50s with blue rubber bleb nevus syndrome presented with headaches, imbalance, decreased visual acuity bilaterally, and left eye proptosis and chemosis. Imaging demonstrated an extensive intraosseous DAVF with dilated intraosseous vascular pouches throughout his cranial base and intraorbital venous congestion. He underwent staged endovascular treatment with the goal to improve his ocular symptoms. Transarterial and transvenous approaches failed to provide adequate access to the intraosseous vascular pouches. A direct, percutaneous transfacial approach was used to access the pouches for embolization with coils and liquid embolic material. Postoperative angiography demonstrated successful embolization of the pouch within the left pterygoid wing, reduced opacification of the intraosseous fistula, and elimination of intraorbital venous congestion. At 9-month follow-up, the patient's headaches had resolved, and his ocular symptomatology had improved. CONCLUSION: Endovascular access to an intraosseous DAVF is limited by the size and location of the intraosseous vascular pouches. In this case, a direct transfacial approach under image guidance facilitated access and embolization, which led to an improvement in the patient's symptoms. This technique is a novel approach for DAVF management.

Download Full-text

Abstract 1122‐000045: Transvenous Embolization of Vein of Galen Aneurismal Malformations Using the “Chapot Pressure Cooker” Technique

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000045 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Maximilian J Bazil ◽

Tomoyoshi Shigematsu ◽

Maximilian J Bazil ◽

Stavros Matsoukas ◽

Johanna T Fifi ◽

...

Keyword(s):

Transarterial Embolization ◽

Arterial Supply ◽

Vein Of Galen ◽

Transvenous Embolization ◽

Newborn Period ◽

Embolic Material ◽

First Report ◽

Delayed Bleeding ◽

Complete Closure ◽

Liquid Embolic

Introduction : There are various procedural techniques described in the literature to treat VGAM: 1) transarterial embolization (TAE) via a transfemoral or transumbilical approach, 2) transfemoral or transtorcular venous coiling, and 3) the combined transarterial and transvenous “trapping” of the fistula. The transarterial technique has permitted our team to obtain total or near‐total obliteration in approximately 80% of cases; however, there is a patient population in whom the residual arterial supply is comprised of small perforators. In these patients, transvenous embolization (TVE) is an attractive option, but its safety is unclear. Here we report the first two VGAM patients treated using the Chapot “pressure cooker” technique (ChPC). Methods : Two patients, one 5‐year‐old and one 7‐year‐old, both presented with congestive heart failure in the newborn period and were subsequently treated in the newborn period with multiple, staged TAEs with n‐BCA for choroidal VGAMs. We achieved progressive reduction in shunting and flow but were unable to accomplish complete closure of the malformation: in both patients, a small residual with numerous perforators persisted. The decision was made to perform transvenous embolization using the CHPC. In this technique, a guiding catheter is placed transjugular into the straight sinus (SS). One or two detachable tip microcatheters are advanced to the origin of the SS. Another microcatheter is advanced and the tip placed between the distal marker and the detachment zone of the former. Coils, and n‐BCA if necessary, are used to prevent reflux of Onyx. This forces the Onyx to occlude the vein and the most distal arterial segment. Results : Both patients had complete occlusion of the VGAM after ChPC. Conclusions : This is the first report to describe TVE to cure VGAM after multiple sessions of TAE. This is also the first report to apply ChPC to VGAM treatment. In this study, we recognized two important factors of traditional VGAM treatment that may cause interventionalists to consider the ChPC to treat VGAM: 1) without liquid embolic, deployed coils may not occlude the fistula entirely. 2) There is the concern of causing delayed bleeding should the arterial component of the fistula rupture. ChPC ameliorates these issues by offering complete closure of the fistula with liquid embolic material in TVE. Not only is the residual vein blocked, but also the incoming arterial supply which prevents delayed bleeding. In endovascular treatment of VGAM, TVE is feasible option once the dilated vein of Galen becomes small enough. To prevent incomplete occlusion or post‐procedural hemorrhagic complications, the use of the ChPC using DMSO liquid embolic material is a promising and necessary introduction to the neurointerventionalist’s treatment arsenal.

Download Full-text

Abstract P495: Aqua Embolic System: Evaluating the Performance of a New Liquid Embolic System Using a Swine AVM Model

Stroke ◽

10.1161/str.52.suppl_1.p495 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Ichiro Yuki ◽

Kousaku Ohkawa ◽

Shiri Li ◽

Earl Steward ◽

Hsu Frank P.K. ◽

...

Keyword(s):

Renal Artery ◽

Organic Solvents ◽

Hemorrhagic Stroke ◽

Cerebrovascular Diseases ◽

Left Renal Artery ◽

Embolic Material ◽

Injection Speed ◽

Rete Mirabile ◽

Brain Avm ◽

Liquid Embolic

Introduction: Liquid embolic material (LEM) plays an essential role in the treatment of hemorrhagic stroke caused by vascular malformation such as arteriovenous malformations (AVMs). However, currently available non-adhesive LEMs has the problem of catheter entrapment, and also known to have cytotoxicity due to the organic solvents such as Dimethyl Sulfoxide (DMSO). Aqua Embolic System (AES) is a new liquid embolic material, which is mainly composed of multiple polysaccharides. AES, when injected via a microcatheter, immediately forms a solid and elastic hydrogel cast upon exposure to Ca2+ in the bloodstream. The use of organic solvents, e.g., DMSO, is not required. The performance of AES was evaluated using an established AVM model utilizing swine rete-mirabile. Methods: Under general anesthesia, the left ascending pharyngeal artery (APA) of Yorkshire swine (40 kg) was catheterized using a microcatheter (ID:0.013 inches), and AES was slowly injected into the rete-mirabile under fluoroscopy. The following parameters were assessed to evaluate the embolization performance of the AES; 1) the amount of AES required for the complete occlusion of the feeding artery, 2) injection speed, 3) radiopacity during the deployment, and 4) incidence of catheter entrapment after the injection. The same evaluation was performed on the contralateral rete-mirabile and the left renal artery as well. Results: 12 arteries in 4 swine were treated, and all arteries were completely occluded without technical complications. The injected materials immediately formed AES cast in all vessels, followed by the reflux over the tip of the microcatheter. All catheters were withdrawn without any sign of catheter entrapment. The AES mixed with tantalum based contrasts medium showed sufficient radiopacity under fluoroscopy. With the injection speed of 0.02ml/sec, the average volume required was 0.85mL for the APA and 2.9mL for the renal artery. No increased thrombogenicity or vasospasm near the treated lesion was observed during the procedure. Conclusions: AES, which is a DMSO free, non-adhesive polysaccharides-based LEM, may be used as an embolic material for the treatment of hemorrhagic stroke caused by cerebrovascular diseases, such as brain AVM.

Download Full-text

Removal of distal fragments of liquid embolic agents during arteriovenous malformation embolization using the TIGERTRIEVER 13: a technical report

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-015474 ◽

2020 ◽

Vol 12 (8) ◽

pp. 794-797 ◽

Cited By ~ 1

Author(s):

Faith LY Ho ◽

René Chapot

Keyword(s):

Cerebral Artery ◽

Endovascular Embolization ◽

Neurological Deficits ◽

Vascular Lesions ◽

Embolic Agent ◽

Embolic Material ◽

Embolic Agents ◽

Liquid Embolic ◽

Retrograde Filling ◽

Distal Migration

BackgroundArteriovenous malformations (AVMs) are vascular lesions that may be treated by an endovascular approach using liquid embolic agents but the control of the liquid embolic agent remains poor and a potential complication may be distal migration of embolic material. The TIGERTRIEVER 13 is a new stent retriever designed for stroke thrombectomy and has a version ideal for distal occlusions. We report our experience in the removal of embolic agent which had migrated into the distal vessels using the TIGERTRIEVER during PHIL/Onyx embolization of AVMs.Clinical presentationsThree patients with brain and spinal AVMs underwent endovascular embolization. During trans-arterial embolization of the AVM with PHIL/Onyx, retrograde filling of distal arterial feeders was followed by migration into the normal arterial branches (cortical middle cerebral artery, distal posterior cerebral artery, and anterior spinal artery). This resulted in occlusion or sluggish distal flow in these branches with potential significant neurological deficits. In all three cases, a Headway Duo microcatheter was navigated distally in the occluded vessel beyond the embolic material using a Traxcess microwire. The TIGERTRIEVER 13 was deployed with recanalization of the vessel after a single attempt. In all three patients there were no complications related to the retrieval of embolic agent.ConclusionDistal migrated embolic agents such as PHIL or Onyx can be removed from various arterial vascular territories using stent retrievers dedicated to small vessels.

Download Full-text