Embolization of Experimental Wide-Necked Aneurysms with Iodine-Containing Polyvinyl Alcohol Solubilized in a Low-Angiotoxicity Solvent

• Published in: American Journal of Neuroradiology Vol. 27; no. 9; pp. 1849 - 1855
• Main Authors: Dudeck, O, Jordan, O, Hoffmann, K.T, Okuducu, A.F, Husmann, I, Kreuzer-Nagy, T, Tesmer, K, Podrabsky, P, Bruhn, H, Hilborn, J, Rufenacht, D.A, Doelker, E, Felix, R
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Am Soc Neuroradiology 01-10-2006; American Society of Neuroradiology
• Subjects: Animals; Biological and medical sciences; Carotid Arteries - drug effects; Carotid Arteries - pathology; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - pathology; Carotid Artery Diseases - therapy; Cerebral Angiography; Chemical Precipitation; Chemistry; Disease Models, Animal; Electrodiagnosis. Electric activity recording; Embolization, Therapeutic - methods; Female; In Vitro Techniques; Injections, Intra-Arterial; Inorganic chemistry; Interventional; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - pathology; Intracranial Aneurysm - therapy; Investigative techniques, diagnostic techniques (general aspects); Kemi; Magnetic Resonance Angiography; Medical sciences; NATURAL SCIENCES; NATURVETENSKAP; Nervous system; Oorganisk kemi; Polyvinyl Alcohol - administration & dosage; Polyvinyl Alcohol - analogs & derivatives; Pyrrolidinones; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Solvents; Swine; Tomography, Spiral Computed; Vascular disease; Nervous system diseases; Radiodiagnosis; Aneurysm; Cardiovascular disease; Alcohol; Embolization; Neck; Solvent; Iodine
• ISSN: 0195-6108; 1936-959X; 1936-959X; 1432-1920

To evaluate the ready-to-use iodine-containing polyvinyl alcohol (I-PVA) dissolved in the low angiotoxic solvent N-methyl pyrrolidone (NMP) for embolization of porcine wide-necked aneurysms.
Fourteen broad-based carotid sidewall aneurysms were surgically constructed in 7 swine. I-PVA (40%) in NMP was injected under temporary balloon occlusion bridging the aneurysm neck. After 4 weeks, follow-up angiography, multisection CT angiography (MSCTA), and 3T MR imaging including MR angiography (MRA) sequences were performed. Afterward, harvested aneurysms were investigated histopathologically.
The liquid embolic was well visible under fluoroscopy and displayed a favorable precipitation pattern, allowing for controlled polymer delivery. Ten aneurysms (71%) were initially completely occluded, whereas in 1 aneurysm, a minimal polymer leakage was observed. The other 4 aneurysms (29%) were almost completely occluded. One animal suffered a lethal rebleeding from the anastomosis after uneventful embolization. Aneurysms embolized with I-PVA could be discriminated well from the parent artery without beam-hardening artifacts on MSCTA, and no susceptibility artifacts were encountered on MR imaging. Histologic examination revealed all aneurysms covered with a membrane of fibroblasts and an endothelial cell layer while a moderate intraaneurysmal inflammatory response to the polymer was observed.
I-PVA dissolved in NMP has proved its effectiveness for the embolization of experimental wide-necked aneurysms. This precipitating liquid embolic offers several interesting features in that it needs no preparation before use and no radiopaque admixtures, the latter allowing for artifact-free evaluation of treated aneurysms with MSCTA and MRA. Moreover, it uses NMP as a solvent, which has only a low angiotoxicity.