scholarly journals Emergency tips recanalisation and gastroesophageal varices embolisation with an ethylene vinyl alcohol copolymer agent (Squid) and detachable coils

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Massimo Venturini ◽  
Luigi Augello ◽  
Carolina Lanza ◽  
Marco Curti ◽  
Andrea Coppola ◽  
...  
Keyword(s):  
Therapeutic Option ◽  
Technical Note ◽  
Embolic Agent ◽  
Refractory Ascites ◽  
Gastroesophageal Varices ◽  
Ethylene Vinyl Alcohol ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Tube Removal ◽  
Detachable Coils

AbstractTransjugular intrahepatic portosystemic shunt (TIPS) is currently indicated as first therapeutic option in the main complications of portal hypertension, including bleeding gastroesophageal varices and refractory ascites. In case of bleeding gastroesophageal varices, an adjuvant embolisation within TIPS can be useful to prevent rebleeding. In the present technical note, the management in emergency of a patient with haemorrhagic shock due to bleeding gastroesophageal varices and occluded TIPS is reported. TIPS recanalisation with an adjunctive stent and high-pressure balloon angioplasty and gastroesophageal varices embolisation using detachable coils and a non-adhesive liquid embolic agent were performed during the same emergent procedure. After the procedure, clinical stabilisation of the patient was achieved, with blood transfusions suspension and Blakemore tube removal. At 6 months, regular TIPS patency at colour Doppler and no rebleeding episodes were recorded. To our knowledge, whilst coils are routinely used for varices embolisation, non-adhesive liquid embolic agents have been never mentioned. Liquid embolic agents seem to provide a stable plug strengthening the embolising action of the coils. Further studies involving a cohort of patients with long-term follow-up will be necessary to confirm whether this association can be more effective than coils alone in gastroesophageal varices embolisation.

scholarly journals Imaging artifacts of Onyx and PHIL on conventional CT, cone-beam CT and MRI in an animal model

2018 ◽  
Vol 24 (6) ◽  
pp. 693-701 ◽  
Author(s):  
Dominik F Vollherbst ◽  
Ruth Otto ◽  
Thuy Do ◽  
Hans U Kauczor ◽  
Martin Bendszus ◽  
...  
Keyword(s):  
Cone Beam Ct ◽  
Cone Beam ◽  
Embolic Agent ◽  
In Vivo Model ◽  
Ethylene Vinyl Alcohol ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Conventional Ct ◽  
Ct And Mri

Background and purpose A frequently reported drawback of ethylene vinyl alcohol copolymer-based liquid embolic agents is the production of artifacts in diagnostic imaging. New embolic agents, such as Precipitating hydrophobic injectable liquid (PHIL; MicroVention, Tustin, CA, USA), are supposed to induce significantly fewer artifacts. The purpose of this study is to assess the degree of artifacts induced by the liquid embolic agents Onyx (Medtronic Neurovascular, Irvine, CA, USA) and PHIL in conventional computed tomography (CT), cone-beam CT and magnetic resonance imaging (MRI) in an experimental in vivo model. Materials and methods In 10 pigs the rete mirabile was embolized with Onyx ( n = 5) or PHIL ( n = 5). After embolization, conventional CT, cone-beam CT and MRI were performed. The degree of artifacts was graded qualitatively (five-point scale; for CT and MRI) and quantitatively (HUs of well-defined regions of interest (ROIs); for CT only). Results Artifacts were significantly more severe for Onyx both in the qualitative (e.g. conventional CT: 2 versus 5 (medians); p = 0.008) and in the quantitative image analysis (e.g. cone-beam CT: standard deviation of a ROI near to the embolic agent cast, 94 HU versus 38 HU (medians); p = 0.008). Neither Onyx nor PHIL produced any apparent artifacts in MRI. Conclusion PHIL produces fewer artifacts than Onyx in conventional CT and cone-beam CT in an experimental in vivo model.

scholarly journals Concomitant Transarterial and Transvenous Embolization of a Pelvic Arteriovenous Malformation Using a New Liquid Embolic Agent, Squid-12 and Detachable Coils

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Aysun Erbahceci Salik ◽  
Filiz Islim ◽  
Ahmet Akgul ◽  
Barbaros Erhan Cil
Keyword(s):  
Embolic Agent ◽  
Transvenous Embolization ◽  
Ethylene Vinyl Alcohol ◽  
Lower Viscosity ◽  
Liquid Embolic ◽  
Internal Iliac ◽  
Liquid Embolic Agent ◽  
Detachable Coils ◽  
Multiple Feeding ◽  
The Right

We describe a complex congenital pelvic AVM with multiple feeding arteries arising from the side branches of the right internal iliac artery and a single draining vein in a male patient. Concomitant transarterial and transvenous embolization with a new liquid embolic agent Squid-12 and metallic coils enabled a complete embolization at a single session. Squid-12 is composed of ethylene vinyl alcohol copolymers and its lower viscosity makes it a promising agent for the treatment of AVMs. The patient showed prompt resolution of the symptoms and complete devascularization of the AVM lesion was persisted on the 1-month control angiography. The patient was asymptomatic on the 6th month follow-up.

Preliminary experience with the liquid embolic material agent PHIL (Precipitating Hydrophobic Injectable Liquid) in treating cranial and spinal dural arteriovenous fistulas: technical note

2015 ◽  
Vol 8 (6) ◽  
pp. 596-602 ◽  
Author(s):  
Joe J Leyon ◽  
Swarupsinh Chavda ◽  
Allan Thomas ◽  
Saleh Lamin
Keyword(s):  
Interventional Neuroradiology ◽  
Technical Note ◽  
Embolic Agent ◽  
Embolic Material ◽  
Arteriovenous Fistulas ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Dural Arteriovenous Fistulas ◽  
Fluoroscopic Time ◽  
Liquid Embolic Agent

BackgroundLiquid embolic agents are the preferred embolic material in endovascular treatment of pial and brain arteriovenous malformations and dural arteriovenous fistulas (DAVFs). There is little choice available in interventional neuroradiology practice other than two of the most commonly used liquid embolic agents—n-butyl cyanoacrylate and the Onyx liquid embolic system (ev3 Neurovascular, Irvine, California, USA). PHIL (Precipitating Hydrophobic Injectable Liquid) (Microvention, Inc California, USA) is a new liquid embolic agent, CE marked and available for clinical use in Europe.ObjectiveTo present our preliminary experience using PHIL in treating cranial and spinal DAVFs.MethodsBetween September 2014 and January 2015, eight patients, with five cranial DAVFs and three spinal DAVFs were treated with PHIL as the sole embolic agent used with intent to cure. Clinical presentation, location of DAVF, Borden type, fluoroscopic time, radiation dose, procedural time, injecting microcatheter used, volume of PHIL injected, complications, immediate angiographic data, premorbid and discharge modified Rankin Scale score, and any neurologic deficits were included in the analysis.ResultsSeven patients were successfully treated with complete angiographic exclusion of the fistula in a single sitting. Treatment failed in one patient where only suboptimal microcatheter positioning could be achieved and PHIL failed to penetrate the fistula's nidus. Venous penetration was achieved in all other patients except one with a small fistula, but with adequate fistula penetration by the embolic material. No other technical complication or neurologic deterioration occurred in any of the patients.ConclusionsPHIL liquid embolic agent appears to be an excellent alternative embolic material with certain advantages compared with other available liquid embolic agents. Further studies are required to fully evaluate its safety and efficacy.

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.

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

2010 ◽  
Vol 112 (3) ◽  
pp. 595-602 ◽  
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.

Embolization of spinal cord arteriovenous malformations with an ethylene vinyl alcohol copolymer dissolved in dimethyl sulfoxide (Onyx liquid embolic system)

2000 ◽  
Vol 93 (2) ◽  
pp. 304-308 ◽  
Author(s):  
Andrew J. Molyneux ◽  
Stuart C. Coley
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformations ◽  
Embolic Agent ◽  
Endovascular Management ◽  
Content Type ◽  
Ethylene Vinyl Alcohol ◽  
Promising Agent ◽  
Liquid Embolic ◽  
Liquid Embolic Agent ◽  
Brain Avms

✓ In this paper the authors describe the first use of a new liquid embolic agent (Onyx) to treat spinal cord arteriovenous malformations (AVMs). Because its properties make it more predictable to use than currently available liquid agents, the authors believe that this material has great potential in the endovascular management of both spinal cord and brain AVMs. This very promising agent merits further clinical study.

scholarly journals Onyx embolization with the Apollo detachable tip microcatheter: A single-center experience

2018 ◽  
Vol 24 (3) ◽  
pp. 339-344 ◽  
Author(s):  
Timothy R Miller ◽  
Luciano Giacon ◽  
Matthew J Kole ◽  
Rong Chen ◽  
Gaurav Jindal ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Embolic Agent ◽  
Ethylene Vinyl Alcohol ◽  
Single Center Experience ◽  
Vessel Injury ◽  
Liquid Embolic ◽  
Liquid Embolic Agent ◽  
Technical Complication ◽  
Neurointerventional Procedures ◽  
Head Neck

Purpose The Apollo Onyx Delivery Microcatheter (Ev3, Irvine, CA) is a detachable-tip microcatheter that was developed to reduce the risk of microcatheter entrapment during ethylene-vinyl alcohol copolymer (Onyx) embolizations. We report our experience with the microcatheter in a variety of neurointerventional procedures. Methods We retrospectively reviewed all Onyx embolizations performed in the head, neck, and spine using the Apollo Onyx Delivery Microcatheter from its introduction at our institution in July 2014 to August 2016. Information regarding patient diagnoses, procedural details, as well as clinical outcomes were obtained from the electronic medical record, procedure reports, and relevant angiographic imaging. Results A total of 58 arterial pedicle Onyx embolizations were performed in 37 patients. There were no cases of microcatheter entrapment, early/inadvertent tip detachment, or vessel injury upon removal of the device. There were two instances (3.5%) of leakage of Onyx from the microcatheter detachment site during embolization, which did not result in adverse sequelae. Clinical outcomes were excellent, with nearly all embolizations achieving the intended goal. In multivariate analysis, length of Onyx reflux along the microcatheter tip and utilization of a higher viscosity agent, Onyx 34, were significantly associated with tip detachment. Conclusion The use of the Apollo Microcatheter is both safe and effective during neurointerventional embolizations using Onyx. Leakage of liquid embolic agent from the detachment site is an infrequent technical complication that may be encountered with the device.

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

2020 ◽  
Vol 12 (8) ◽  
pp. 794-797 ◽  
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.

Endovascular Treatment of Side Wall Aneurysms Using a Liquid Embolic Agent

Neurosurgery ◽  
2010 ◽  
Vol 67 (3) ◽  
pp. 855-860 ◽  
Author(s):  
Scott D. Simon ◽  
Eric Eskioglu ◽  
Adam Reig ◽  
Robert A. Mericle
Keyword(s):  
United States ◽  
Side Wall ◽  
The United States ◽  
Lessons Learned ◽  
Embolic Agent ◽  
Ethylene Vinyl Alcohol ◽  
Advantages And Disadvantages ◽  
Liquid Embolic ◽  
Multicenter Randomized Controlled Trial ◽  
Liquid Embolic Agent

Abstract OBJECTIVE Onyx HD-500 is a liquid embolic agent consisting of ethylene vinyl alcohol copolymer dissolved in dimethylsulfoxide and mixed with tantalum. This viscous embolic agent was designed to treat intracranial side wall aneurysms, but there have been no prospective published series from the United States. From this early experience, we developed several protocol revisions, technical details, and clinical pearls that have not been published for liquid embolic embolization of aneurysms. CLINICAL PRESENTATION We present our single-center prospective series of patients treated with Onyx HD-500 from a multicenter, randomized, controlled trial. Thirteen patients received Onyx HD-500, and their ages ranged from 43 to 81 years. Twelve patients had aneurysms on the internal carotid artery, and 1 patient had an aneurysm the vertebral artery. Every patient had an immediate postangiographic result with 90% or more occlusion by an independent core laboratory assessment. In 1 patient, the Onyx HD-500 injection was aborted, and the aneurysm was embolized with coils. Eleven of 13 patients (85%) underwent 6-month follow-up angiography that demonstrated persistent durable occlusion with no recanalization. There was 1 complication (8%) and no deaths. CONCLUSION This is the only prospective series of intracranial aneurysms treated with Onyx HD-500 in the United States. This is also the first publication that describes detailed procedure techniques, recommended protocol revisions, lessons learned from early complications, clinical pearls, and advantages and disadvantages of liquid embolic embolization of aneurysms.

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