title: Chitosan-Sodium Tetradecyl Sulfate Hydrogel: Characterization and Preclinical Evaluation of a Novel Sclerosing Embolizing Agent for the Treatment of Endoleaks.
abstract: OBJECTIVE
  To compare the efficacy of an embolization agent with sclerosing properties (made of chitosan and sodium tetradecyl sulfate, CH-STS) with a similar embolization agent but without sclerosing properties (made of chitosan, CH) in treating endoleaks in a canine endovascular aneurysm repair model.
  
  
  METHODS
  Two chitosan-based radiopaque hydrogels were prepared, one with STS and one without STS. Their rheological, injectability, and embolizing properties were assessed in vitro; afterwards, their efficacy in occluding endoleaks was compared in a canine bilateral aneurysm model reproducing type I endoleaks (n = 9 each). The primary endpoint was endoleak persistence at 3 or 6 months, assessed on a CT scan and macroscopic examination. Secondary endpoints were the occurrence of stent-graft (SG) thrombosis, the evolution of the aneurysm mean diameter, as well as aneurysm healing and inflammation scores in pathology examinations.
  
  
  RESULTS
  In vitro experiments showed that both products gelled rapidly and presented initial storage moduli greater than 800 Pa, which increased with time. Both gels were compatible with microcatheter injection and occlude flow up to physiological pressure in vitro. In a type I endoleak model, the injection of CH-STS sclerosing gel tended to reduce the risk of occurrence of endoleaks, compared to CH non-sclerosing agent (2/9 vs. 6/9, p = 0.069). No case of SG thrombosis was observed. Moderate inflammation was found around both gels, with a comparable intensity score in both CH and CH-STS groups (2.6 ± 0.9 and 2.7 ± 0.9, respectively; p = 0.789).
  
  
  CONCLUSIONS
  Flow occlusion combined with chemical endothelial denudation appears promising for the treatment of endoleaks.
  
  
  METHODS
  N/A.
authors.affiliation: Department of Mechanical Engineering, École de technologie supérieure, 1100 Notre-Dame Street West, Montreal, QC, H3C 1K3, Canada.|Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 St Denis, Tour Viger, Montreal, QC, H2X 0A9, Canada.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Zehtabi
authors.affiliation: Département de pathologie, Centre hospitalier de l'Université de Montréal, Montreal, Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: Dumont-Mackay
authors.affiliation: Department of Mechanical Engineering, École de technologie supérieure, 1100 Notre-Dame Street West, Montreal, QC, H3C 1K3, Canada.|Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 St Denis, Tour Viger, Montreal, QC, H2X 0A9, Canada.|Faculté Polydisciplinaire, Department of Chemistry, Université Sultan Moulay Slimane, Mghila BP:592, 23000, Beni-Mellal, Morocco.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Fatimi
authors.affiliation: Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 St Denis, Tour Viger, Montreal, QC, H2X 0A9, Canada.|Department of Radiology, Université de Montréal, Montreal, QC, H2L 4M1, Canada.
authors.forename: Antony
authors.initials: A
authors.lastname: Bertrand-Grenier
authors.affiliation: Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 St Denis, Tour Viger, Montreal, QC, H2X 0A9, Canada.
authors.forename: Hélène
authors.initials: H
authors.lastname: Héon
authors.affiliation: Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 St Denis, Tour Viger, Montreal, QC, H2X 0A9, Canada.|Department of Radiology, Université de Montréal, Montreal, QC, H2L 4M1, Canada.
authors.forename: Gilles
authors.initials: G
authors.lastname: Soulez
authors.affiliation: Department of Mechanical Engineering, École de technologie supérieure, 1100 Notre-Dame Street West, Montreal, QC, H3C 1K3, Canada. Sophie.lerouge@etsmtl.ca.|Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 St Denis, Tour Viger, Montreal, QC, H2X 0A9, Canada. Sophie.lerouge@etsmtl.ca.|Department of Radiology, Université de Montréal, Montreal, QC, H2L 4M1, Canada. Sophie.lerouge@etsmtl.ca.
authors.forename: Sophie
authors.identifier: http://orcid.org/0000-0002-4992-5552
authors.initials: S
authors.lastname: Lerouge
mesh_terms: D000818:Animals; D048271:Chitosan / Q000008:administration & dosage*; D004195:Disease Models, Animal; D004285:Dogs; D004621:Embolization, Therapeutic / Q000379:methods*; D057867:Endoleak / Q000628:therapy*; D057510:Endovascular Procedures / Q000379:methods; D020100:Hydrogels / Q000008:administration & dosage*; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D012981:Sodium Tetradecyl Sulfate / Q000008:administration & dosage*
chemical_list: D020100:Hydrogels; D012597:Sclerosing Solutions; D048271:Chitosan; D012981:Sodium Tetradecyl Sulfate
keywords: Chitosan; Embolization; Endoleak; Endovascular aneurysm repair; Hydrogels; Sclerosing agent