title: Intrinsically radiopaque iodine-containing polyvinyl alcohol as a liquid embolic agent: evaluation in experimental wide-necked aneurysms.
abstract: OBJECTIVE
  To evaluate iodine-containing polyvinyl alcohol (I-PVA) as a precipitating liquid embolic agent, implant characteristics--including radiopacity, setting behavior, and biocompatibility--were studied in an aneurysm model in swine.
  
  
  METHODS
  Twelve broad-based carotid artery (CA) sidewall aneurysms were surgically constructed in six pigs. Iodine-containing polyvinyl alcohol dissolved in dimethyl sulfoxide (DMSO) was injected during temporary balloon occlusion bridging the aneurysm neck. Control angiography as well as multidetector row computerized tomography (CT) angiography was performed after 4 weeks. Harvested aneurysms were investigated histopathologically and by 3-tesla high-field magnetic resonance (MR) imaging. The mean degree of aneurysm occlusion achieved was 96%. In two aneurysms a minimal protrusion of I-PVA into the CA lumen was observed. During one embolization, leakage of the liquid embolic agent due to DMSO-induced damage of the microcatheter resulted in CA occlusion. Aneurysms embolized with I-PVA could be discriminated clearly from the parent artery on CT angiograms because there was no beam-hardening artifact. High-field MR imaging allowed a detailed depiction of the liquid embolic distribution within the aneurysm. Histologically, a mild to moderate inflammatory response was found in successfully embolized aneurysms, and the polymer mass was frequently covered by a membrane of fibroblasts and endothelial cells.
  
  
  CONCLUSIONS
  Iodine-containing polyvinyl alcohol is a ready-to-use liquid embolic agent clearly visible under fluoroscopy; additives are not required. The setting behavior allows for controlled delivery in aneurysm cavities. Histological studies performed 4 weeks after embolization revealed no sign of toxic tissue response to the liquid embolic agent. Overall, I-PVA exhibits interesting implant characteristics in that radiopaque admixtures are not necessary, thus allowing for artifact-free evaluation of treated aneurysms by using CT and MR angiography.
authors.affiliation: Department of Radiology, Charité, Campus Virchow Clinic, Berlin, Germany. oliver.dudeck@charite.de
authors.forename: Oliver
authors.initials: O
authors.lastname: Dudeck
authors.forename: Olivier
authors.initials: O
authors.lastname: Jordan
authors.forename: Karl-Titus
authors.initials: KT
authors.lastname: Hoffmann
authors.forename: Kai
authors.initials: K
authors.lastname: Tesmer
authors.forename: Tibor
authors.initials: T
authors.lastname: Kreuzer-Nagy
authors.forename: Petr
authors.initials: P
authors.lastname: Podrabsky
authors.forename: Michael
authors.initials: M
authors.lastname: Heise
authors.forename: Rudolf
authors.initials: R
authors.lastname: Meyer
authors.forename: Ali Fuat
authors.initials: AF
authors.lastname: Okuducu
authors.forename: Harald
authors.initials: H
authors.lastname: Bruhn
authors.forename: Jöns
authors.initials: J
authors.lastname: Hilborn
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Rüfenacht
authors.forename: Eric
authors.initials: E
authors.lastname: Doelker
authors.forename: Roland
authors.initials: R
authors.lastname: Felix
mesh_terms: D000783:Aneurysm / Q000628:therapy*; D000818:Animals; D002340:Carotid Artery Diseases / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D007455:Iodine / Q000493:pharmacokinetics / Q000627:therapeutic use*; D018810:Magnetic Resonance Angiography; D011142:Polyvinyl Alcohol / Q000493:pharmacokinetics / Q000627:therapeutic use*; D013552:Swine; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D011142:Polyvinyl Alcohol; D007455:Iodine