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  • Evaluation of a novel liquid embolic agent (precipitating hydrophobic injectable liquid (PHIL)) in an animal endovascular embolization model

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Evaluation of a novel liquid embolic agent (precipitating hydrophobic injectable liquid (PHIL)) in an animal endovascular embolization model
  1. Dominik F Vollherbst1,2,
  2. Ruth Otto1,
  3. Andreas von Deimling3,
  4. Johannes Pfaff1,
  5. Christian Ulfert1,
  6. Hans U Kauczor2,
  7. Martin Bendszus1,
  8. Christof M Sommer2,4,
  9. Markus A Möhlenbruch1
  1. 1 Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
  2. 2 Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
  3. 3 Department of Neuropathology, University Hospital Heidelberg, CCU Neuropathology, DKTK and DKFZ, Heidelberg, Germany
  4. 4 Clinic for Diagnostic and Interventional Radiology, Klinikum Stuttgart, Stuttgart, Germany
  1. Correspondence to Dr Markus A Möhlenbruch, Department of Neuroradiology, University Hospital Heidelberg, INF 400, Heidelberg 69120, Germany; markus.moehlenbruch{at}med.uni-heidelberg.de

Abstract

Background The choice of the embolic agent and the embolization technique can have a significant impact on the success of endovascular embolization.

Objective To 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 methods Sixteen 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.

Results Embolization 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.

Conclusion PHIL 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.

  • arteriovenous malformation
  • liquid embolic material
  • intervention

https://doi.org/10.1136/neurintsurg-2017-013144

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    Footnotes

    • CMS and MAM contributed equally.

    • Contributors All listed authors contributed to the work. DFV, CMS and MAM acquired, analyzed and interpreted data for the work; designed the study; drafted the manuscript and approved the final manuscript. RO acquired, analyzed and interpreted data for the work; drafted the manuscript and approved the final manuscript. AD analyzed and interpreted data for the work; drafted the manuscript and approved the final manuscript. JP, CU, HUK and MB analyzed and interpreted data for the work; drafted the manuscript and approved the final manuscript.

    • Funding This study was technically supported by MicroVention (Tustin, USA) and Medtronic Neurovascular (Irvine, USA).

    • Competing interests JP reports personal fees from Siemens Healthcare GmbH and personal fees from Stryker GmbH & Co KG, outside the submitted work. HK reports grants, personal fees and non-financial support from Siemens, personal fees from Boehringer Ingelheim, personal fees and non-financial support from Bayer, personal fees from GSK, personal fees from Novartis, personal fees from Astra Zeneca, personal fees from Philips, personal fees from Bracco, outside the submitted work. MB: reports board membership: DSMB Vascular Dynamics; consultancy: Roche, Guerbet, Codman; grants/grants pending: DFG, Hopp Foundation, Novartis, Siemens, Guerbet, Stryker, Covidien; payment for lectures (including service on speakers' bureaus): Novartis, Roche, Guerbet, Teva, Bayer, Codman. HK: reports grants, personal fees and non-financial support from Siemens, personal fees from Boehringer Ingelheim, personal fees and non-financial support from Bayer, personal fees from GSK, personal fees from Novartis, personal fees from Astra Zeneca, personal fees from Philips, personal fees from Bracco, outside the submitted work. MM: has received consulting honoraria, speaker honoraria, and travel support outside this work from Codman, Covidien/Medtronic, MicroVention, Phenox, and Stryker. All other authors have no competing interests to disclose.

    • Provenance and peer review Not commissioned; externally peer reviewed.