Surgical handling characteristics of an ethylene vinyl alcohol copolymer compared with N-butyl cyanoacrylate used for embolization of vessels in an arteriovenous malformation resection model in swine

2003 ◽  
Vol 98 (2) ◽  
pp. 366-370 ◽  
Author(s):  
Eric D. Akin ◽  
Eddie Perkins ◽  
Ian B. Ross
Keyword(s):  
Blood Loss ◽  
Arteriovenous Malformation ◽  
Vinyl Alcohol ◽  
Treated Group ◽  
Content Type ◽  
Ethylene Vinyl Alcohol ◽  
Ethylene Vinyl Alcohol Copolymer ◽  
Rete Mirabile ◽  
Handling Characteristics ◽  
Fine Print

Object. There have been significant improvements in neurovascular technology and implants over the past decade. One such material, N-butyl cyanoacrylate (NBCA), is now commercially available for cerebral arteriovenous malformation (AVM) embolization in the US. An ethylene vinyl alcohol copolymer preparation, Onyx, which is currently being evaluated, is approved for use outside North America. Although reports indicate that Onyx may be superior to NBCA from an endovascular perspective, little information exists about its surgical handling characteristics. The purpose of this study was to compare the surgical handling characteristics of Onyx-treated vessels with those of NBCA-embolized vessels in an AVM resection model. Methods. Fourteen pigs (two groups of seven) were anesthetized. A femoral artery was cannulated, followed by selective catheterization of the ascending pharyngeal arteries. Nidal rete mirabile (RM) embolizations were performed using either 6% Onyx or 20% NBCA. After angiographically confirmed obliteration of flow in the right RM, microsurgical resection of this structure was performed. Surgical handling characteristics of the embolized RM were rated on a scale of 1 to 5 and blood loss was recorded. Different surgeons performed the embolizations and resections. The surgeon who performed resections was blinded to the embolization agent used, and the data analysis was also performed in a blinded fashion. The surgical handling scores were superior (p < 0.05) in the Onyx-treated group. Although there was also less blood loss in this group, the difference was not significant. Subjectively, the surgeon who performed the resections believed that Onyx was softer and handled better than NBCA. Conclusions. Onyx, which may offer endovascular advantages, also seems to provide benefits for the surgeon.

A nonadhesive liquid embolic agent composed of ethylene vinyl alcohol copolymer and ethanol mixture for the treatment of cerebral arteriovenous malformations: experimental study

2002 ◽  
Vol 97 (4) ◽  
pp. 889-895 ◽  
Author(s):  
Jun-Ichiro Hamada ◽  
Yutaka Kai ◽  
Motohiro Morioka ◽  
Kiyoshi Kazekawa ◽  
Yasuji Ishimaru ◽  
...  
Keyword(s):  
Renal Artery ◽  
Vinyl Alcohol ◽  
Arteriovenous Malformations ◽  
Embolic Agent ◽  
Ethanol Mixture ◽  
Content Type ◽  
Ethylene Vinyl Alcohol ◽  
Ethylene Vinyl Alcohol Copolymer ◽  
Delivery Technique ◽  
Fine Print

Object. The authors have developed a mixture of ethylene vinyl alcohol copolymer (EVAL) and iopamidol, which is dissolved in ethanol, as an alternative solvent to provide a safe means of embolizing arteriovenous malformations (AVMs). Methods. A two-stage delivery technique is required to prevent premature precipitation in the catheter when using this material: the catheter is first infused with 30% ethanol and this is followed by the delivery of the EVAL—ethanol mixture. Acute angiographic changes were analyzed after superselective delivery of dimethyl sulfoxide (DMSO) and 30% ethanol into the renal artery of rabbits. Histological changes following the embolization of the renal artery achieved using the EVAL—ethanol mixture were recorded at 1 hour and at 2 and 16 weeks after the procedure. Although DMSO always produced severe, rapidly progressive vasospasm in the renal artery during a 1- to 60-minute postinfusion, 30% ethanol did not. Microscopically, the lumens of embolized vessels examined 1 hour after embolization with EVAL—ethanol appeared to be filled with EVAL sponges, leaving almost no open spaces. The space between the EVAL sponges and the inner surface of the vessels was filled with fresh thrombus. In the vessel walls of specimens examined 2 weeks after embolization there was no or a slight inflammatory reaction. Scattered in the EVAL sponges were almost equal numbers of neutrophilic granulocytes and mononuclear cells, indicative of a mild inflammatory response. In specimens examined 16 weeks postembolization, the changes noted at 2 weeks were intensified. There was no definite histopathological evidence of mural hemorrhage, perivascular extravasation of the mixture, or perivascular hemorrhage in any specimen that was examined. Conclusions. Although the degree of permanence of this embolization material is yet unknown, the mixture was easy to handle, and appeared safe and effective for AVM embolization. Its nonadhesive characteristic and its ability to be infused by repeated injections make it an attractive alternative to currently available materials. The good results obtained in this study led us to undertake a clinical trial, the results of which are contained in a companion article in this issue of the Journal of Neurosurgery.

Cobb's syndrome and its treatment with embolization

1990 ◽  
Vol 72 (3) ◽  
pp. 497-499 ◽  
Author(s):  
Shin-ichi Miyatake ◽  
Haruhiko Kikuchi ◽  
Tomoaki Koide ◽  
Sen Yamagata ◽  
Izumi Nagata ◽  
...  
Keyword(s):  
Vinyl Alcohol ◽  
Content Type ◽  
Ethylene Vinyl Alcohol ◽  
Fine Print

✓ A case of Cobb's syndrome, which is characterized by spinal and vertebral angiomas and a skin nevus at the same metameric level, is reported. The spinal angiomas were treated with liquid embolization using ethylene vinyl alcohol.

Effect of α-adrenergic blockade on the cerebrovascular response to increased intracranial pressure after hemorrhage

1998 ◽  
Vol 89 (3) ◽  
pp. 454-459 ◽  
Author(s):  
Ingunn R. Rise ◽  
Ole J. Kirkeby
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Intracranial Pressure ◽  
Blood Loss ◽  
Treated Group ◽  
Control Group ◽  
Adrenergic Blockade ◽  
Content Type ◽  
Cerebrovascular Resistance ◽  
Fine Print

Object. In this study the authors tested the hypothesis that hemorrhagic hypotension and high intracranial pressure induce an increase in cerebrovascular resistance that is caused by sympathetic compensatory mechanisms and can be modified by α-adrenergic blockade. Methods. Continuous measurements of cerebral blood flow were obtained using laser Doppler microprobes placed in the cerebral cortex in anesthetized pigs during induced hemorrhagic hypotension and high cerebrospinal fluid pressure. Eight pigs received 2 mg/kg phentolamine in 10 ml saline, and 13 pigs served as control animals. During high intracranial pressure occurring after blood loss, cerebral perfusion pressure (CPP) (p < 0.01) and cerebral blood flow (p < 0.01) decreased in both groups. Cerebrovascular resistance increased (p < 0.05) in the control group and decreased < 0.005) in the phentolamine-treated group. The cerebrovascular resistance was significantly lower in the phentolamine-treated group (p < 0.05) than in the control group. Cerebrovascular resistance increased at lower CPPs in the control group (linear correlation, r = 0.39, p < 0.01) and decreased with decreasing CPP in the phentolamine-treated group (linear correlation, r = 0.76, p < 0.001). Conclusions. This study shows that the deleterious effects on cerebral hemodynamics induced by blood loss in combination with high intracranial pressure are inhibited by α-adrenergic blockade. This suggests that these responses are caused by α-adrenergically mediated cerebral vasoconstriction.

A mixture of ethylene vinyl alcohol copolymer and ethanol yielding a nonadhesive liquid embolic agent to treat cerebral arteriovenous malformations: initial clinical experience

2002 ◽  
Vol 97 (4) ◽  
pp. 881-888 ◽  
Author(s):  
Jun-Ichiro Hamada ◽  
Yutaka Kai ◽  
Motohiro Morioka ◽  
Kiyoshi Kazekawa ◽  
Yasuji Ishimaru ◽  
...  
Keyword(s):  
Clinical Experience ◽  
Vinyl Alcohol ◽  
Arteriovenous Malformations ◽  
Embolic Agent ◽  
Ethanol Mixture ◽  
Content Type ◽  
Ethylene Vinyl Alcohol ◽  
Liquid Embolic ◽  
Liquid Embolic Agent ◽  
Fine Print

Object. The authors report their clinical experience with their new nonadhesive liquid embolic agent, an ethylene vinyl alcohol copolymer (EVAL)/ethanol mixture, to treat arteriovenous malformations (AVMs). Methods. Between June 1995 and April 2001, 57 patients with confirmed AVMs underwent embolization of their lesions with the EVAL/ethanol mixture. In 87 procedures consisting of one to three stages, the authors embolized 185 feeding arteries to occlude as much of the AVM as possible. Repeated injections under fluoroscopic control could be performed smoothly without encountering cementing of the catheter to the vessel wall. Among the 87 embolizations undertaken in 57 patients, seven procedures (8%) in six patients produced new postembolization symptoms. Resolution of these symptoms occurred within hours or days after four of the seven procedures; permanent neurological deficits remained after the other three procedures (3.4%). Of the 57 patients, three underwent postembolization radiosurgery, and 54 underwent radical treatment with microsurgical extirpation. Histopathological examination of the 54 specimens disclosed mild inflammation within the embolized lumen without inflammatory reactions in the media or adventitia. Follow-up angiograms obtained 3 years after radiosurgery was administered showed that in all three patients treated in this fashion the nidus had completely disappeared. Conclusions. The EVAL/ethanol mixture is handled easily and appears to be an effective and safe agent for preoperative embolization of AVMs.

Embolization of arteriovenous malformations with peripheral aneurysms using ethylene vinyl alcohol copolymer

1991 ◽  
Vol 75 (4) ◽  
pp. 655-660 ◽  
Author(s):  
Tomoaki Terada ◽  
Yoshinari Nakamura ◽  
Kunio Nakai ◽  
Mitsuharu Tsuura ◽  
Takashi Nishiguchi ◽  
...  
Keyword(s):  
Vinyl Alcohol ◽  
Arteriovenous Malformations ◽  
Neurological Deficits ◽  
Embolic Agent ◽  
Feeding Artery ◽  
Content Type ◽  
Ethylene Vinyl Alcohol ◽  
Ethylene Vinyl Alcohol Copolymer ◽  
Liquid Embolic ◽  
Mapping Techniques

✓ The authors report three cases of arteriovenous malformations (AVM's) with aneurysms arising from the feeding artery; all were successfully treated with a new nonadhesive liquid embolic material, ethylene vinyl alcohol copolymer (EVAL). In two patients the AVM's were totally removed without difficulty, and in one the AVM was managed conservatively after embolization. No new neurological deficits appeared during or after embolization. After road-mapping techniques, EVAL was injected slowly until the feeding artery and aneurysm were completely obliterated. This embolic agent is easy to handle and is considered safe compared with other adhesive liquid embolic agents, such as isobutyl-2-cyanoacrylate or n-butyl cyanoacrylate. It is concluded that EVAL is an excellent agent for embolizing an AVM with a peripheral aneurysm on the feeding artery.

Sign in / Sign up

Export Citation Format

Share Document