A novel, non-adhesive, precipitating liquid embolic implant with intrinsic radiopacity: feasibility and safety animal study.
OBJECTIVE
To evaluate a novel, ready-to-use, iodinated polyvinyl alcohol polymer embolic implant.


METHODS
Under good laboratory practice conditions, 26 pigs were investigated. A complex arteriovenous malformation (AVM) model was created in 16 animals, and a simple rete model was used in the remaining 10 animals. The novel material was used for embolization in 22 animals, and a commercially available liquid embolic material in 4 animals as a control group. Animals were killed at 2 days, 3 months and 6 months. Feasibility, efficacy and safety were evaluated radiologically, clinically and histologically.


RESULTS
Preparation was easy, without risk of catheter clogging or adhesiveness. Embolic delivery was well controlled under subtracted fluoroscopy. Visibility was homogeneous throughout the injection and the material behaved cohesively upon delivery. Best lesion penetration was obtained with the use of proximal microballoon occlusion. Unforeseen over-dilution of the test material by DMSO prefilled in the microballoon hub changed the material properties and caused inadvertent cerebral embolization leading to death in five animals. This phenomenon was avoided by practical measures. The casts produced no beam-hardening artefacts on CT scans. Histology showed excellent biocompatibility.


CONCLUSIONS
Embolization with this novel, iodinated, precipitating polymer was feasible and effective. Care should be taken during delivery to avoid over-dilution of the material by prefilled DMSO. The material is promising for embolization of AVMs and hypervascular lesions.


CONCLUSIONS
• The intrinsically opaque precipitating polymer has adequate fluoroscopic visibility • The polymer does not induce shading or beam-hardening artefacts on CT • The novel liquid embolic material does not require lengthy preparation • Lack of implant adherence reduces the risk of entrapment of the delivery catheter.
Service of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Rue Gabrielle-Perret-gentil 4, 1211, Geneva, Switzerland. kulcsarzsolt22@gmail.com.|Interventional Work Research, CABMM, University of Zurich, Zurich, Switzerland. kulcsarzsolt22@gmail.com.
Zsolt
Z
Kulcsár
Musculoskeletal Research Unit, VETSUISSE, University of Zurich, Zurich, Switzerland.
Agnieszka
A
Karol
Musculoskeletal Research Unit, VETSUISSE, University of Zurich, Zurich, Switzerland.|Veterinary Anaesthesia Services-International, Winterthur, Switzerland.
Peter W
PW
Kronen
Musculoskeletal Research Unit, VETSUISSE, University of Zurich, Zurich, Switzerland.
Pfundstein
P
Svende
Musculoskeletal Research Unit, VETSUISSE, University of Zurich, Zurich, Switzerland.
Karina
K
Klein
School of Pharmaceutical Sciences, University of Geneva & University of Lausanne, Geneva, Switzerland.|Antia Therapeutics, Bern, Switzerland.
Olivier
O
Jordan
Interventional Work Research, CABMM, University of Zurich, Zurich, Switzerland.|Neuroradiology, Swiss Neuro Institute, Clinic Hirslanden, Zurich, Switzerland.|Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany.
Isabel
I
Wanke
D000818:Animals; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D004195:Disease Models, Animal; D004621:Embolization, Therapeutic / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D011108:Polymers; D011142:Polyvinyl Alcohol / Q000008:administration & dosage*; D013552:Swine; D014057:Tomography, X-Ray Computed
D011108:Polymers; D011142:Polyvinyl Alcohol
Arteriovenous malformation; Dural fistula; Easyx; Embolization; Liquid embolic