Skip to main content
Erschienen in: CardioVascular and Interventional Radiology 6/2019

13.02.2019 | Laboratory Investigation

The Novel X-Ray Visible Zein-Based Non-adhesive Precipitating Liquid Embolic HEIE1_2017: An Exploratory Study

verfasst von: Dominik F. Vollherbst, Thuy D. Do, Manfred Jugold, Viktoria Eichwald, Stephan Macher-Göppinger, Philippe L. Pereira, Martin Bendszus, Markus A. Möhlenbruch, Götz M. Richter, Hans U. Kauczor, Christof M. Sommer

Erschienen in: CardioVascular and Interventional Radiology | Ausgabe 6/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To investigate the novel zein-based non-adhesive precipitating liquid embolic HEIE1_2017.

Materials and Methods

Zein-based liquid embolics are an own class of embolization material. In this study, HEIE1_2017, a novel zein-based liquid embolic, was investigated. Visibility was assessed in vitro in CT and MRI phantoms, embolization characteristics were assessed in vivo in the kidneys of 12 pigs. Components of HEIE1_2017 were zein as occlusion material, ethanol as solvent, and iodized oil as radiopaque material. HEIE1_2017 was used in pure (HEI-PURE) and manually modified (HEI-MOD) form and compared with 6% ethylene vinyl alcohol copolymer (EVOH). Different radiological methods (CT, MRI, DSA, cone-beam CT, and micro-CT) and histopathologic analyses were applied to compare visibility and vascular occlusion patterns.

Results

In CT phantoms, all embolics were definitely visible as hyperdense materials. In MRI phantoms, signal-to-noise ratio was highest for HEI-PURE, followed by HEI-MOD and EVOH. In all kidneys, embolization procedures were technically successful and without complications. In DSA, all embolics were definitely visible during and after embolization. Only EVOH caused substantial artifacts in cone-beam CT and CT. In micro-CT and histopathology, HEI-PURE showed a homogeneous occlusion from segmental arteries to glomerular capillaries. HEI-MOD demonstrated the deepest vascular penetration (up to the level of peritubular capillaries), but with an inhomogeneous distribution. For EVOH, there was inhomogeneous vascular occlusion from segmental arteries to glomerular capillaries.

Conclusion

HEIE1_2017 is a promising novel zein-based liquid embolic. Further preclinical and clinical studies with higher case numbers and long-term follow-up are needed to further assess the value of this embolic material.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Akmangit I, Daglioglu E, Kaya T, et al. Preliminary experience with squid: a new liquid embolizing agent for AVM, AV fistulas and tumors. Turk Neurosurg. 2014;24(4):565–70. Akmangit I, Daglioglu E, Kaya T, et al. Preliminary experience with squid: a new liquid embolizing agent for AVM, AV fistulas and tumors. Turk Neurosurg. 2014;24(4):565–70.
2.
Zurück zum Zitat Bartling SH, Budjan J, Aviv H, et al. First multimodal embolization particles visible on X-ray/computed tomography and magnetic resonance imaging. Investig Radiol. 2011;46(3):178–86.CrossRef Bartling SH, Budjan J, Aviv H, et al. First multimodal embolization particles visible on X-ray/computed tomography and magnetic resonance imaging. Investig Radiol. 2011;46(3):178–86.CrossRef
3.
Zurück zum Zitat Bisdorff A, Mazighi M, Saint-Maurice JP, Chapot R, Lukaszewicz AC, Houdart E. Ethanol threshold doses for systemic complications during sclerotherapy of superficial venous malformations: a retrospective study. Neuroradiology. 2011;53(11):891–4.CrossRefPubMed Bisdorff A, Mazighi M, Saint-Maurice JP, Chapot R, Lukaszewicz AC, Houdart E. Ethanol threshold doses for systemic complications during sclerotherapy of superficial venous malformations: a retrospective study. Neuroradiology. 2011;53(11):891–4.CrossRefPubMed
4.
Zurück zum Zitat Brown PA, Zomorodi AR, Gonzalez LF. Endovascular management of spinal dural arteriovenous fistulas. Handb Clin Neurol. 2017;143:199–213.CrossRefPubMed Brown PA, Zomorodi AR, Gonzalez LF. Endovascular management of spinal dural arteriovenous fistulas. Handb Clin Neurol. 2017;143:199–213.CrossRefPubMed
5.
Zurück zum Zitat Buecker A, Keulers P, Guenther RW. Successful closure and embolization of a fistula between the pancreatic duct and a pseudocyst using ethibloc. Cardiovasc Interv Radiol. 1997;20(5):394–6.CrossRef Buecker A, Keulers P, Guenther RW. Successful closure and embolization of a fistula between the pancreatic duct and a pseudocyst using ethibloc. Cardiovasc Interv Radiol. 1997;20(5):394–6.CrossRef
6.
Zurück zum Zitat De Beule T, Vranckx J, Verhamme P, et al. Transarterial embolization of peripheral arteriovenous malformations with ethylenevinyl alcohol copolymer: feasibility, technical outcomes, and clinical outcomes. Vasa. 2016;45(6):497–504.CrossRefPubMed De Beule T, Vranckx J, Verhamme P, et al. Transarterial embolization of peripheral arteriovenous malformations with ethylenevinyl alcohol copolymer: feasibility, technical outcomes, and clinical outcomes. Vasa. 2016;45(6):497–504.CrossRefPubMed
7.
Zurück zum Zitat Desir A, Ghaye B, Duysinx B, Dondelinger RF. Percutaneous sclerotherapy of a giant mediastinal lymphangioma. Eur Respir J. 2008;32(3):804–6.CrossRefPubMed Desir A, Ghaye B, Duysinx B, Dondelinger RF. Percutaneous sclerotherapy of a giant mediastinal lymphangioma. Eur Respir J. 2008;32(3):804–6.CrossRefPubMed
8.
Zurück zum Zitat Doerfler A, Goericke S, Wanke I, Holla M, Forsting M. Flow-directed microcatheters for cerebral embolizations using Ethibloc: an in vitro study. Neuroradiology. 2001;43(12):1112–7.CrossRefPubMed Doerfler A, Goericke S, Wanke I, Holla M, Forsting M. Flow-directed microcatheters for cerebral embolizations using Ethibloc: an in vitro study. Neuroradiology. 2001;43(12):1112–7.CrossRefPubMed
9.
Zurück zum Zitat Elsenousi A, Aletich VA, Alaraj A. Neurological outcomes and cure rates of embolization of brain arteriovenous malformations with n-butyl cyanoacrylate or Onyx: a meta-analysis. J Neurointerv Surg. 2016;8(3):265–72.CrossRefPubMed Elsenousi A, Aletich VA, Alaraj A. Neurological outcomes and cure rates of embolization of brain arteriovenous malformations with n-butyl cyanoacrylate or Onyx: a meta-analysis. J Neurointerv Surg. 2016;8(3):265–72.CrossRefPubMed
10.
Zurück zum Zitat Eom HJ, Shin JH, Cho YJ, Nam DH, Ko GY, Yoon HK. Transarterial embolisation of renal arteriovenous malformation: safety and efficacy in 24 patients with follow-up. Clin Radiol. 2015;70(11):1177–84.CrossRefPubMed Eom HJ, Shin JH, Cho YJ, Nam DH, Ko GY, Yoon HK. Transarterial embolisation of renal arteriovenous malformation: safety and efficacy in 24 patients with follow-up. Clin Radiol. 2015;70(11):1177–84.CrossRefPubMed
11.
Zurück zum Zitat George HL, Unnikrishnan PN, Garg NK, Sampath JS, Bass A, Bruce CE. Long-term follow-up of Ethibloc injection in aneurysmal bone cysts. J Pediatr Orthop B. 2009;18(6):375–80.CrossRefPubMed George HL, Unnikrishnan PN, Garg NK, Sampath JS, Bass A, Bruce CE. Long-term follow-up of Ethibloc injection in aneurysmal bone cysts. J Pediatr Orthop B. 2009;18(6):375–80.CrossRefPubMed
12.
Zurück zum Zitat Gross BA, Albuquerque FC, Moon K, McDougall CG. Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas. J Neurosurg. 2017;126(6):1884–93.CrossRef Gross BA, Albuquerque FC, Moon K, McDougall CG. Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas. J Neurosurg. 2017;126(6):1884–93.CrossRef
13.
Zurück zum Zitat Gross BA, Moon K, McDougall CG. Endovascular management of arteriovenous malformations. Handb Clin Neurol. 2017;143:59–68.CrossRefPubMed Gross BA, Moon K, McDougall CG. Endovascular management of arteriovenous malformations. Handb Clin Neurol. 2017;143:59–68.CrossRefPubMed
14.
Zurück zum Zitat Hansmann HJ, Hallscheidt P, Aretz K, Kauffmann GW, Richter GM. Renal tumor embolization. Radiologe. 1999;39(9):783–9.CrossRefPubMed Hansmann HJ, Hallscheidt P, Aretz K, Kauffmann GW, Richter GM. Renal tumor embolization. Radiologe. 1999;39(9):783–9.CrossRefPubMed
15.
Zurück zum Zitat Kauffmann GW, Richter GM, Rohrbach R, Wenz W. Prolonged survival following palliative renal tumor embolization by capillary occlusion. Cardiovasc Interv Radiol. 1989;12(1):22–8.CrossRef Kauffmann GW, Richter GM, Rohrbach R, Wenz W. Prolonged survival following palliative renal tumor embolization by capillary occlusion. Cardiovasc Interv Radiol. 1989;12(1):22–8.CrossRef
16.
Zurück zum Zitat Khaja MS, Park AW, Swee W, et al. Treatment of type II endoleak using Onyx with long-term imaging follow-up. Cardiovasc Interv Radiol. 2014;37(3):613–22.CrossRef Khaja MS, Park AW, Swee W, et al. Treatment of type II endoleak using Onyx with long-term imaging follow-up. Cardiovasc Interv Radiol. 2014;37(3):613–22.CrossRef
17.
Zurück zum Zitat Klauss M, Heye T, Stampfl U, Grenacher L, Radeleff B. Successful arterial embolization of a giant pseudoaneurysm of the gastroduodenal artery secondary to chronic pancreatitis with literature review. J Radiol Case Rep. 2012;6(2):9–16.PubMedPubMedCentral Klauss M, Heye T, Stampfl U, Grenacher L, Radeleff B. Successful arterial embolization of a giant pseudoaneurysm of the gastroduodenal artery secondary to chronic pancreatitis with literature review. J Radiol Case Rep. 2012;6(2):9–16.PubMedPubMedCentral
18.
Zurück zum Zitat Konya A, Wright KC. Capillary embolization using ethiodol-ethanol for complete renal ablation in Swine. Investig Radiol. 2002;37(9):512–20.CrossRef Konya A, Wright KC. Capillary embolization using ethiodol-ethanol for complete renal ablation in Swine. Investig Radiol. 2002;37(9):512–20.CrossRef
19.
Zurück zum Zitat Kramer SC, Gorich J, Rilinger N, et al. Embolization for gastrointestinal hemorrhages. Eur Radiol. 2000;10(5):802–5.CrossRefPubMed Kramer SC, Gorich J, Rilinger N, et al. Embolization for gastrointestinal hemorrhages. Eur Radiol. 2000;10(5):802–5.CrossRefPubMed
20.
Zurück zum Zitat Lubicz B, Piotin M, Mounayer C, Spelle L, Moret J. Selective endovascular treatment of intracranial aneurysms with a liquid embolic: a single-center experience in 39 patients with 41 aneurysms. AJNR Am J Neuroradiol. 2005;26(4):885–93.PubMed Lubicz B, Piotin M, Mounayer C, Spelle L, Moret J. Selective endovascular treatment of intracranial aneurysms with a liquid embolic: a single-center experience in 39 patients with 41 aneurysms. AJNR Am J Neuroradiol. 2005;26(4):885–93.PubMed
21.
Zurück zum Zitat Mironov A. Embolization of meningiomas using liquid embolizing agents. Rofo. 1990;153(3):327–34.CrossRefPubMed Mironov A. Embolization of meningiomas using liquid embolizing agents. Rofo. 1990;153(3):327–34.CrossRefPubMed
22.
23.
Zurück zum Zitat Radeleff B, Schawo S, Hoffmann K, et al. Efficacy and safety of percutaneous transhepatic portal embolization before right liver resection using an ethibloc/lipiodol mixture: a single-center experience. Dig Surg. 2008;25(1):52–9.CrossRefPubMed Radeleff B, Schawo S, Hoffmann K, et al. Efficacy and safety of percutaneous transhepatic portal embolization before right liver resection using an ethibloc/lipiodol mixture: a single-center experience. Dig Surg. 2008;25(1):52–9.CrossRefPubMed
24.
Zurück zum Zitat Rangel-Castilla L, Shah AH, Klucznik RP, Diaz OM. Preoperative Onyx embolization of hypervascular head, neck, and spinal tumors: experience with 100 consecutive cases from a single tertiary center. J Neurointerv Surg. 2014;6(1):51–6.CrossRefPubMed Rangel-Castilla L, Shah AH, Klucznik RP, Diaz OM. Preoperative Onyx embolization of hypervascular head, neck, and spinal tumors: experience with 100 consecutive cases from a single tertiary center. J Neurointerv Surg. 2014;6(1):51–6.CrossRefPubMed
25.
Zurück zum Zitat Rassweiler J, Prager P, Haferkamp A, Alken P, Kauffmann GW, Richter G. Transarterial nephrectomy: the current status of experimental and clinical studies. J Endourol. 2008;22(4):767–82.CrossRefPubMed Rassweiler J, Prager P, Haferkamp A, Alken P, Kauffmann GW, Richter G. Transarterial nephrectomy: the current status of experimental and clinical studies. J Endourol. 2008;22(4):767–82.CrossRefPubMed
26.
Zurück zum Zitat Richter G, Rassweiler J, Kauffmann GW, Wenz W, Crawford DB. Experimental study of the effectiveness of capillary embolization using contrast-enhanced Ethibloc. Invest Radiol. 1984;19(1):36–44.CrossRefPubMed Richter G, Rassweiler J, Kauffmann GW, Wenz W, Crawford DB. Experimental study of the effectiveness of capillary embolization using contrast-enhanced Ethibloc. Invest Radiol. 1984;19(1):36–44.CrossRefPubMed
27.
Zurück zum Zitat Roberts DA, Balter JM, Chaudhary N, Gemmete JJ, Pandey AS. Dosimetric measurements of Onyx embolization material for stereotactic radiosurgery. Med Phys. 2012;39(11):6672–81.CrossRefPubMed Roberts DA, Balter JM, Chaudhary N, Gemmete JJ, Pandey AS. Dosimetric measurements of Onyx embolization material for stereotactic radiosurgery. Med Phys. 2012;39(11):6672–81.CrossRefPubMed
28.
Zurück zum Zitat Sadeh-Gonike U, Magand N, Armoiry X, et al. Transarterial Onyx embolization of intracranial dural fistulas: a prospective cohort, systematic review, and meta-analysis. Neurosurgery. 2018;82(6):854–63.CrossRefPubMed Sadeh-Gonike U, Magand N, Armoiry X, et al. Transarterial Onyx embolization of intracranial dural fistulas: a prospective cohort, systematic review, and meta-analysis. Neurosurgery. 2018;82(6):854–63.CrossRefPubMed
29.
Zurück zum Zitat Saeed Kilani M, Izaaryene J, Cohen F, et al. Ethylene vinyl alcohol copolymer (Onyx(R)) in peripheral interventional radiology: indications, advantages and limitations. Diagn Interv Imaging. 2015;96(4):319–26.CrossRefPubMed Saeed Kilani M, Izaaryene J, Cohen F, et al. Ethylene vinyl alcohol copolymer (Onyx(R)) in peripheral interventional radiology: indications, advantages and limitations. Diagn Interv Imaging. 2015;96(4):319–26.CrossRefPubMed
30.
Zurück zum Zitat Sommer CM, Stampfl U, Bellemann N, et al. Patients with life-threatening arterial renal hemorrhage: CT angiography and catheter angiography with subsequent superselective embolization. Cardiovasc Interv Radiol. 2010;33(3):498–508.CrossRef Sommer CM, Stampfl U, Bellemann N, et al. Patients with life-threatening arterial renal hemorrhage: CT angiography and catheter angiography with subsequent superselective embolization. Cardiovasc Interv Radiol. 2010;33(3):498–508.CrossRef
31.
Zurück zum Zitat Vollherbst DF, Otto R, Do T, et al. Imaging artifacts of Onyx and PHIL on conventional CT, cone-beam CT and MRI in an animal model. Interv Neuroradiol. 2018;24:693–701.CrossRefPubMed Vollherbst DF, Otto R, Do T, et al. Imaging artifacts of Onyx and PHIL on conventional CT, cone-beam CT and MRI in an animal model. Interv Neuroradiol. 2018;24:693–701.CrossRefPubMed
32.
Zurück zum Zitat Vollherbst DF, Otto R, von Deimling A, et al. Evaluation of a novel liquid embolic agent (precipitating hydrophobic injectable liquid (PHIL)) in an animal endovascular embolization model. J Neurointerv Surg. 2018;10(3):268–74.CrossRefPubMed Vollherbst DF, Otto R, von Deimling A, et al. Evaluation of a novel liquid embolic agent (precipitating hydrophobic injectable liquid (PHIL)) in an animal endovascular embolization model. J Neurointerv Surg. 2018;10(3):268–74.CrossRefPubMed
33.
Zurück zum Zitat Vollherbst DF, Sommer CM, Ulfert C, Pfaff J, Bendszus M, Mohlenbruch MA. Liquid embolic agents for endovascular embolization: evaluation of an established (Onyx) and a novel (PHIL) embolic agent in an in vitro AVM model. AJNR Am J Neuroradiol. 2017;38(7):1377–82.CrossRefPubMed Vollherbst DF, Sommer CM, Ulfert C, Pfaff J, Bendszus M, Mohlenbruch MA. Liquid embolic agents for endovascular embolization: evaluation of an established (Onyx) and a novel (PHIL) embolic agent in an in vitro AVM model. AJNR Am J Neuroradiol. 2017;38(7):1377–82.CrossRefPubMed
Metadaten
Titel
The Novel X-Ray Visible Zein-Based Non-adhesive Precipitating Liquid Embolic HEIE1_2017: An Exploratory Study
verfasst von
Dominik F. Vollherbst
Thuy D. Do
Manfred Jugold
Viktoria Eichwald
Stephan Macher-Göppinger
Philippe L. Pereira
Martin Bendszus
Markus A. Möhlenbruch
Götz M. Richter
Hans U. Kauczor
Christof M. Sommer
Publikationsdatum
13.02.2019
Verlag
Springer US
Erschienen in
CardioVascular and Interventional Radiology / Ausgabe 6/2019
Print ISSN: 0174-1551
Elektronische ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-019-02179-9

Weitere Artikel der Ausgabe 6/2019

CardioVascular and Interventional Radiology 6/2019 Zur Ausgabe

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.