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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 23:422-429, March 2002
© 2002 American Society of Neuroradiology

INTERVENTIONAL

Liquid 2-Poly-Hydroxyethyl-Methacrylate Embolization of Experimental Arteriovenous Malformations: Feasibility Study

Joachim Klisch^a,b, Lin Yin^a,b, Flavio Requejo^a,b,f, Barbara Eissner^c, Kai M. Scheufler^b, Ralf Kubalek^,b, Markus Buechner^a, Axel Pagenstecher^d, Heiner Nagursky^e and Martin Schumacher^a,

^a Section of Neuroradiology, University of Freiburg, Germany
^b Departments of Neurosurgery, University of Freiburg, Germany
^c Surgery–Surgical Research, University of Freiburg, Germany
^d Neuropathology, University of Freiburg, Germany
^e Oral and Maxillofacial Surgery, University of Freiburg, Germany
^f Department of Neurosurgery, Hospital Municipal, Buenos Aires, Argentina

Address reprint requests to Joachim Klisch, MD, Section of Neuroradiology, University of Freiburg, Breisacher Str 64, D-79106 Freiburg, Germany

BACKGROUND AND PURPOSE: We investigated the use of 2-poly-hydroxyethyl-methacrylate (2-P-HEMA) as an embolic agent in swine arteriovenous malformations (AVMs).

METHODS: In seven mini swine, experimental AVMs were created surgically. The aim of treatment was complete embolization of the nidus compartment filled by the feeding artery, without brain embolization. Six animals received pure liquid 2-P-HEMA, and one, 50% 2-P-HEMA. For radiopacity, liquid 2-P-HEMA was mixed with tungsten powder. Six animals underwent angiographic follow-up within 5–8 mo (mean, 6.5 mo). Evaluation criteria were controllability, procedural reproducibility, and duration of the nidus occlusion. To detect complications, brain MR imaging and CT were performed. Histopathologic studies were performed to prove occlusion and assess histopathologic responses.

RESULTS: 2-P-HEMA was easily injected through microcatheters, with a reproducible technique. Because of the radiopacity of the mixture, deep nidus penetration was controlled with fluoroscopy and confirmed with CT and histopathologic examination. In five AVMs embolized with pure 2-P-HEMA, feeder obliteration was long term. One animal had vasospasm during embolization, and complete obliteration of the main feeder was maintained for 3 mo, but partial recanalization developed 2 mo later. One animal receiving pure 2-P-HEMA had an infarction. In the animal embolized with 50% 2-P-HEMA, angiography and CT revealed embolic material in the circle of Willis; the animal died after embolization. No marked inflammatory reaction in the vessel wall or perivascular tissue was observed in the embolized AVMs.

CONCLUSION: Experimental AVM embolization with pure 2-P-HEMA, made radiopaque with tungsten, is technically feasible in swine. Because of its properties, 2-P-HEMA has great potential as a therapeutic embolic agent.

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