scholarly journals Initial experience with precipitating hydrophobic injectable liquid in cerebral arteriovenous malformations

2018 ◽  
Vol 25 (1) ◽  
pp. 58-65 ◽  
Author(s):  
Stanimir S Sirakov ◽  
Alexander Sirakov ◽  
Krasimir Minkin ◽  
Hristo Hristov ◽  
Kristian Ninov ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Endovascular Embolization ◽  
Embolic Agent ◽  
Initial Experience ◽  
Cerebral Arteriovenous Malformations ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Reported Study ◽  
Liquid Embolic Agent ◽  
Staged Treatment

Background Precipitating hydrophobic injectable liquid is a newly introduced liquid embolic agent for endovascular embolization with some technical advantages over other liquid embolic agents. We present our initial experience with precipitating hydrophobic injectable liquid in the endovascular treatment of cerebral arteriovenous malformations. Methods From October 2015 to January 2018, 27 patients harboring cerebral arteriovenous malformations underwent endovascular embolization with precipitating hydrophobic injectable liquid 25. Clinical features, angiographic results, procedural details, complications, and follow-up details were retrospectively analyzed. Results Twenty-seven patients with cerebral arteriovenous malformations were included. Total obliteration in one endovascular session was confirmed for 14/27 (52%) patients. Partial embolization was attained in 13 patients (48%) in whom staged treatment with following radiosurgery or surgery was planned. No mortality was recorded in this series. Complications during or after the embolization occurred in six of 27 (22.2%) patients. Conclusion In our initial experience, precipitating hydrophobic injectable liquid has acceptable clinical outcome comparable to other liquid embolic agents. Although this is the largest reported study in arteriovenous malformation treatment with precipitating hydrophobic injectable liquid, further studies are needed to validate its safety and efficacy.

scholarly journals Glue, Onyx, Squid or PHIL? Liquid Embolic Agents for the Embolization of Cerebral Arteriovenous Malformations and Dural Arteriovenous Fistulas

2021 ◽  
Author(s):  
Dominik F. Vollherbst ◽  
René Chapot ◽  
Martin Bendszus ◽  
Markus A. Möhlenbruch
Keyword(s):  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Endovascular Embolization ◽  
Embolic Agent ◽  
Cerebral Arteriovenous Malformations ◽  
Arteriovenous Fistulas ◽  
Advantages And Disadvantages ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Dural Arteriovenous Fistulas

Abstract Background Endovascular embolization is an effective treatment option for cerebral arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs). A variety of liquid embolic agents have been and are currently used for embolization of AVMs and DAVFs. Knowledge of the special properties of the agent which is used is crucial for an effective and safe embolization procedure. Material and Methods This article describes the properties and indications of the liquid embolic agents which are currently available: cyanoacrylates (also called glues), and the copolymers Onyx, Squid and PHIL, as well as their respective subtypes. Results Cyanoacrylates were the predominantly used agents in the 1980s and 1990s. They are currently still used in specific situations, for example for the occlusion of macro-shunts, for the pressure cooker technique or in cases in which microcatheters are used that are not compatible with dimethyl-sulfoxide. The first broadly used copolymer-based embolic agent Onyx benefits from a large amount of available experience and data, which demonstrated its safety and efficacy in the treatment of cerebral vascular malformations, while its drawbacks include temporary loss of visibility during longer injections and artifacts in cross-sectional imaging. The more recently introduced agents Squid and PHIL aim to overcome these shortcomings and to improve the success rate of endovascular embolization. Novelties of these newer agents with potential advantages include extra-low viscosity versions, more stable visibility, and a lower degree of imaging artifacts. Conclusion All the available liquid embolic agents feature specific potential advantages and disadvantages over each other. The choice of the most appropriate embolic agent must be made based on the specific material characteristics of the agent, related to the specific anatomical characteristics of the target pathology.

Evaluation of a novel liquid embolic agent (precipitating hydrophobic injectable liquid (PHIL)) in an animal endovascular embolization model

2017 ◽  
Vol 10 (3) ◽  
pp. 268-274 ◽  
Author(s):  
Dominik F Vollherbst ◽  
Ruth Otto ◽  
Andreas von Deimling ◽  
Johannes Pfaff ◽  
Christian Ulfert ◽  
...  
Keyword(s):  
Waiting Time ◽  
Transarterial Embolization ◽  
Endovascular Embolization ◽  
Embolic Agent ◽  
Rete Mirabile ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Liquid Embolic Agent ◽  
Group Survival

BackgroundThe choice of the embolic agent and the embolization technique can have a significant impact on the success of endovascular embolization.ObjectiveTo evaluate a novel iodinated copolymer-based liquid embolic agent (precipitating hydrophobic injectable liquid (PHIL)) in the porcine rete mirabile (RM), serving as an endovascular embolization model. Onyx, as an established liquid embolic agent, served as comparator.Materials and methodsSixteen embolization procedures were performed using PHIL (n=8) or Onyx (n=8) as liquid embolic agent. Waiting time between injections was set to 30 or 60 s (n=4 per study group). Survival time after intervention was 2 hours or 7 days. Embolization characteristics (eg, procedure times, number of injections and volume of embolic agent) and embolization extent (percentage of embolized RM in post-interventional x-ray) were assessed. Post-interventional CT and histopathological analyses were performed.ResultsEmbolization characteristics and embolization extent were not significantly different for PHIL and Onyx, including subgroups (eg, embolization extent 44% vs 69% (medians); p=0.101). For PHIL, extension of the waiting time from 30 to 60 s led to a significantly higher embolization extent (24% vs 72% (medians); p=0.035). Moderate disintegration and mild inflammation of the embolized blood vessels were present for both embolic agents.ConclusionPHIL is feasible for transarterial embolization in an acute and subacute endovascular embolization model. In this preliminary experimental in vivo study, embolization characteristics, embolization extent, and biocompatibility seem to be similar to those of Onyx.

Initial experience with the new ethylene vinyl alcohol copolymer based liquid embolic agent Menox in the endovascular treatment of cerebral arteriovenous malformations

2019 ◽  
Vol 11 (10) ◽  
pp. 1040-1044 ◽  
Author(s):  
Stanimir Sirakov ◽  
Alexander Sirakov ◽  
Krasimir Minkin ◽  
Marin Penkov ◽  
Kristian Ninov ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Vinyl Alcohol ◽  
Arteriovenous Malformations ◽  
Embolic Agent ◽  
Initial Experience ◽  
Cerebral Arteriovenous Malformations ◽  
Ethylene Vinyl Alcohol ◽  
Arteriovenous Shunts ◽  
Liquid Embolic

Background and PurposeLiquid embolic agents (LEAs) are the determinant tool for successful embolization of cranial arteriovenous shunts. There are few currently available LEAs. The aim of the study was to summarize our initial experience with a recently introduced non-adhesive ethylene vinyl alcohol (EVOH) copolymer based LEA (Menox 18) in the endovascular treatment of cerebral arteriovenous malformations.MethodsFrom April 2018 to November 2018, 24 patients harboring cerebral arteriovenous malformations underwent endovascular embolization with Menox 18. Clinical features, angiographic results, procedural details, complications, and follow-up details were prospectively collected and retrospectively analyzed.ResultsCurative embolization in one endovascular session was achieved in 14/24 (58.3%) of the treated patients. Partial embolization was achieved in 10 patients (42.6%) in whom staged treatment with radiosurgery or microsurgical resection was planned. No mortality was recorded in our series. Clinical complications after embolization occurred in 1/24 (4.66%) patients. No technical complications were notedConclusionsOur pilot study suggests that the Menox embolization system offers similar technical and clinical results in comparison with the other currently available LEAs. Further studies with larger cohorts and long term follow-up data are needed to fully evaluate its efficacy

Curing arteriovenous malformations using embolization

2014 ◽  
Vol 37 (3) ◽  
pp. E19 ◽  
Author(s):  
Matthew B. Potts ◽  
Daniel W. Zumofen ◽  
Eytan Raz ◽  
Peter K. Nelson ◽  
Howard A. Riina
Keyword(s):  
Arteriovenous Malformations ◽  
Endovascular Embolization ◽  
Cerebral Arteriovenous Malformations ◽  
Curative Intent ◽  
The Past ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Diagnostic Angiography ◽  
Endovascular Technology

Endovascular embolization is typically reserved as an adjuvant therapy in the management of cerebral arteriovenous malformations (AVMs), either for preoperative devascularization or preradiosurgical volume reduction. Curative embolization plays a limited role in AVM treatment but several studies have shown that it is possible, especially with later-generation liquid embolic agents. Given the complexity of AVM anatomy and the recent controversies over the role of any intervention in AVM management, it is critical that the cerebrovascular community better define the indications of each treatment modality to provide quality AVM management. In this review, the authors evaluate the role of curative AVM embolization. Important considerations in the feasibility of curative AVM embolization include whether it can be performed reliably and safely, and whether it is a durable cure. Studies over the past 20 years have begun to define the anatomical factors that are amenable to complete endovascular occlusion, including size, feeding artery anatomy, AVM morphology, and endovascular accessibility. More recent studies have shown that highly selected patients with AVMs can be treated with curative intent, leading to occlusion rates as high as 100% of such prospectively identified lesions with minimal morbidity. Advances in endovascular technology and techniques that support the efficacy and safety of curative embolization are discussed, as is the importance of superselective diagnostic angiography. Finally, the durability of curative embolization is analyzed. Overall, while still unproven, endovascular embolization has the potential to be a safe, effective, and durable curative treatment for select AVMs, broadening the armamentarium with which one can treat this disease.

scholarly journals Precipitating hydrophobic injectable liquid embolization of intracranial vascular shunts: initial experience and technical note

2018 ◽  
Vol 129 (5) ◽  
pp. 1217-1222 ◽  
Author(s):  
Shriram Varadharajan ◽  
Arvinda Hanumanthapura Ramalingaiah ◽  
Jitender Saini ◽  
Arun Kumar Gupta ◽  
B. Indira Devi ◽  
...  
Keyword(s):  
Endovascular Embolization ◽  
Technical Note ◽  
Embolic Agent ◽  
Arteriovenous Fistulas ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Complete Obliteration ◽  
Liquid Embolic Agent ◽  
Pial Arteriovenous Fistula

Precipitating hydrophobic injectable liquid (PHIL) is a newly available liquid embolic agent for endovascular therapy. It is nonadhesive and composed of a biocompatible polymer dissolved in dimethyl sulfoxide solvent and bonded covalently with iodine.In this report, the authors present their preliminary experience using PHIL in the treatment of intracranial vascular shunts. Between July 2015 and December 2015, 11 patients underwent endovascular embolization using the PHIL embolic agent. Five patients had arteriovenous malformations, 4 had dural arteriovenous fistulas, 1 patient had a carotid-cavernous fistula, and 1 patient had a pial arteriovenous fistula. Clinical features, angioarchitectural characteristics, procedural details, and periprocedural complications were included in the analysis.Complete or near-complete obliteration of the nidus or fistulas was achieved in 8 of these patients. Partial embolization (approximately 80% in 2 and 30% in 1) was attained in the other 3 patients. Satisfactory venous penetration after nidal embolization was achieved in all patients. In 1 patient, the microcatheter could not be retrieved. No other major complications related to PHIL injection were noted during the procedure or periprocedural period. Clinical follow-up ranging from 8 months to 1 year showed good outcomes in all but 1 patient, who experienced an intraventricular hemorrhage 6 weeks after embolization.PHIL appears to be an effective alternative embolic material with certain advantages over other available liquid embolic agents. Further studies with adequate follow-up are required to fully evaluate its safety and efficacy.

scholarly journals Investigation of a New Version of the Liquid Embolic Agent PHIL with Extra-Low-Viscosity in an Endovascular Embolization Model

2018 ◽  
Vol 39 (9) ◽  
pp. 1696-1702 ◽  
Author(s):  
D.F. Vollherbst ◽  
R. Otto ◽  
M. Hantz ◽  
C. Ulfert ◽  
H.U. Kauczor ◽  
...  
Keyword(s):  
Endovascular Embolization ◽  
Embolic Agent ◽  
Low Viscosity ◽  
Liquid Embolic ◽  
Liquid Embolic Agent

Embolization of Arteriovenous Malformations with Onyx: Clinicopathological Experience in 23 Patients

Neurosurgery ◽  
2001 ◽  
Vol 48 (5) ◽  
pp. 984-997 ◽  
Author(s):  
Reza Jahan ◽  
Yuichi Murayama ◽  
Y. Pierre Gobin ◽  
Gary R. Duckwiler ◽  
Harry V. Vinters ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Ease Of Use ◽  
Neurological Deficits ◽  
Embolic Agent ◽  
Liquid Embolic ◽  
Liquid Embolic Agent ◽  
Martin Grade ◽  
Permanent Morbidity ◽  
Arterial Feeder ◽  
Inflammatory Changes

Abstract OBJECTIVE To report our experience in treatment of arteriovenous malformations (AVMs) using a new liquid embolic agent, Onyx (Micro Therapeutics, Inc., Irvine, CA). METHODS Between January 1998 and May 1999, 23 patients (8 men and 15 women) were treated. The patients' average age was 40 years, with seizure being the most common presenting symptom (39%). The average Spetzler-Martin grade on presentation was 3. The average AVM volume before embolization was 14.5 cm3. RESULTS We observed an average 63% reduction in AVM volume after 129 arterial feeders were embolized. There were four adverse events. Two patients experienced ischemia because of inadvertent occlusion of an arterial feeder. One of these patients made a full recovery, but the other patient had a permanent deficit. Two other patients experienced transient neurological deficits that resolved within 1 week of embolization. Permanent morbidity was thus 4% (1 of 23 patients). There were no deaths. Twelve patients underwent subsequent radiosurgery, and 11 patients had surgery that resulted in complete resection of their AVMs. Histopathological examinations showed mild acute inflammation in specimens resected 1 day after embolization. Chronic inflammatory changes were observed in specimens resected more than 4 days after embolization. In two patients, angionecrosis of the embolized vessels was noted. No evidence of parenchymal hemorrhage was observed in these patients, and vessel wall integrity was maintained as well. CONCLUSION Onyx is a new nonadhesive liquid embolic agent that has been used to treat 23 patients at our institution with good results. Its nonadhesive nature and ease of use make it a promising agent in the future treatment of AVMs.

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