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

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.

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Our First Experience of Simultaneous Endovascular Embolization of Proximal Flow-Related Aneurysm and Arteriovenous Malformation of the Brain with Liquid Embolic Agent

Neurosurgery Cases and Reviews ◽

10.23937/2643-4474/1710027 ◽

2019 ◽

Vol 2 (2) ◽

Author(s):

Sufianov AA ◽

Karasev SM ◽

Khafizov RR ◽

Sufianov RA

Keyword(s):

Arteriovenous Malformation ◽

Endovascular Embolization ◽

Embolic Agent ◽

Liquid Embolic ◽

Liquid Embolic Agent ◽

The Brain

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Initial experience with precipitating hydrophobic injectable liquid in cerebral arteriovenous malformations

Interventional Neuroradiology ◽

10.1177/1591019918798808 ◽

2018 ◽

Vol 25 (1) ◽

pp. 58-65 ◽

Cited By ~ 4

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.

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

Journal of Neurosurgery ◽

10.3171/2017.6.jns16447 ◽

2018 ◽

Vol 129 (5) ◽

pp. 1217-1222 ◽

Cited By ~ 5

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.

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