title: New Alcohol and Onyx Mixture for Embolization: Feasibility and Proof of Concept in Both In Vitro and In Vivo Models.
abstract: BACKGROUND
  Onyx and ethanol are well-known embolic and sclerotic agents that are frequently used in embolization. These agents present advantages and disadvantages regarding visibility, injection control and penetration depth. Mixing both products might yield a new product with different characteristics. The aim of this study is to evaluate the injectability, radiopacity, and mechanical and occlusive properties of different mixtures of Onyx 18 and ethanol in vitro and in vivo (in a swine model).
  
  
  METHODS
  Various Onyx 18 and ethanol formulations were prepared and tested in vitro for their injectability, solidification rate and shrinkage, cohesion and occlusive properties. In vivo tests were performed using 3 swine. Ease of injection, radiopacity, cohesiveness and penetration were analyzed using fluoroscopy and high-resolution CT.
  
  
  RESULTS
  All mixtures were easy to inject through a microcatheter with no resistance or blockage in vitro and in vivo. The 50%-ethanol mixture showed delayed copolymerization with fragmentation and proximal occlusion. The 75%-ethanol mixture showed poor radiopacity in vivo and was not tested in vitro. The 25%-ethanol mixture showed good occlusive properties and accepted penetration and radiopacity.
  
  
  CONCLUSIONS
  Mixing Onyx and ethanol is feasible. The mixture of 25% of ethanol and 75% of Onyx 18 could be a new sclero-embolic agent. Further research is needed to study the chemical changes of the mixture, to confirm the significance of the added sclerotic effect and to find out the ideal mixture percentages.
authors.affiliation: Hôpital cardiologique, Centre Hospitalier Universitaire (CHRU) de Lille, Boulevard Jules LECLERQ, 59037, Lille, France. msaeedkilani@gmail.com.|Experimental Interventional Imaging Laboratory, CERIMED, Marseilles, France. msaeedkilani@gmail.com.
authors.forename: Mohammad
authors.identifier: http://orcid.org/0000-0003-4947-3645
authors.initials: M
authors.lastname: Saeed Kilani
authors.affiliation: Department of Mechanical Engineering, école de technologie supérieure (ETS) & CHUM Research center (CRCHUM), Montreal, Canada.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Zehtabi
authors.affiliation: Department of Mechanical Engineering, école de technologie supérieure (ETS) & CHUM Research center (CRCHUM), Montreal, Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Lerouge
authors.affiliation: Department of Radiology, Centre Hospitalier de l'Université de Montréal, 1560 Sherbrooke East, H2L 4M1, Montreal, Canada.|Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Montreal, Canada.
authors.forename: Gilles
authors.initials: G
authors.lastname: Soulez
authors.affiliation: Department of Medical Imaging, University Hospital Timone, Marseilles, France.
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Bartoli
authors.affiliation: Hôpital cardiologique, Centre Hospitalier Universitaire (CHRU) de Lille, Boulevard Jules LECLERQ, 59037, Lille, France.|Aix-Marseille University, Marseille, France.|Interventional Radiology Section, Department of Medical Imaging, University Hospital TIMONE, Marseille, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Vidal
authors.affiliation: Radiology Department, King Faisal Specialist Hospital and Research Center, MBC 28, PO Box 3354, Riyadh, 11211, Saudi Arabia.
authors.forename: Mohammad F
authors.initials: MF
authors.lastname: Badran
mesh_terms: D000818:Animals; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004621:Embolization, Therapeutic / Q000379:methods*; D000431:Ethanol / Q000008:administration & dosage*; D005240:Feasibility Studies; D005471:Fluoroscopy; D006801:Humans; D066298:In Vitro Techniques; D007267:Injections; D023421:Models, Animal; D011145:Polyvinyls / Q000008:administration & dosage*; D012077:Renal Artery / Q000000981:diagnostic imaging; D012212:Rheology; D013552:Swine; D013635:Tantalum / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed
chemical_list: D004338:Drug Combinations; C558446:Onyx 18; D011145:Polyvinyls; D000431:Ethanol; D013635:Tantalum
keywords: Embolization; Ethanol; Onyx