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Original research
Assessment of human placenta as an ex-vivo vascular model for testing of liquid embolic agent injections with adjunctive techniques
  1. Hideo Okada1,2,
  2. Joonho Chung1,3,4,
  3. Daniel M Heiferman5,
  4. Demetrius K Lopes1
  1. 1 Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
  2. 2 Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama, Japan
  3. 3 Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
  4. 4 Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Republic of Korea
  5. 5 Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
  1. Correspondence to Dr Demetrius K Lopes, Department of Neurological Surgery, Rush University Medical Center, Chicago, IL 60612, USA; Demetrius_Lopes{at}


Purpose This project sought to test the utility of post-delivery human placenta (HP) as a vascular model for liquid embolic agent (LEA) simulation, along with adjunctive techniques.

Materials and methods Twelve LEA injections were performed under fluoroscopy in HP with two reflux control methods: dual lumen ‘mini’ balloon-catheter (n=9); and injection after proximal nBCA plug formation through a second microcatheter (‘pressure cooker’) (n=3). Measured outcomes included liquid embolic agent (LEA) advancement and reflux. Reflux was categorized into three grades: grade 0=no reflux; grade 1=occlusion of side branches without reflux beyond the balloon or plug; and grade 2=reflux beyond the balloon or plug.

Results Simulation success was greater when a balloon was used rather than with a nBCA plug (89% vs 33%, P=0.054). In eight successful balloon-assisted injections, the reflux grades were: 50% grade 0; 12.5% grade 1; and 37.5% grade 2. The one successful nBCA plug injection had grade 2 reflux. All grade 2 balloon injections occurred when the balloon was positioned across a vessel bifurcation.

Conclusions HP provides excellent simulation for liquid embolic agents with a dual lumen balloon catheter.

  • liquid embolic material
  • technique
  • balloon

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  • Contributors DKL conceived the study. HO, JC, and DKL executed this study. HO performed acquisition and analysis of data for work and drafted it. DMH reviewed the manuscript critically and revised it. All authors reviewed the final version of the manuscript.

  • Funding Medtronic, Microvention Terumo, Asahi Intec, Codman, and Stryker supported this study by donating the endovascular devices.

  • Competing interests None declared.

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