Advanced

AJNR - American Journal of Neuroradiology

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Dudeck, O. Articles by Felix, R. Search for Related Content PubMed PubMed Citation Articles by Dudeck, O. Articles by Felix, R.

American Journal of Neuroradiology 27:1849-1855, October 2006
© 2006 American Society of Neuroradiology

INTERVENTIONAL

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

O. Dudeck^a, O. Jordan^d, K.T. Hoffmann^a, A.F. Okuducu^b, I. Husmann^c, T. Kreuzer-Nagy^a, K. Tesmer^a, P. Podrabsky^a, H. Bruhn^a, J. Hilborn^e, D.A. Rüfenacht^f, E. Doelker^d and R. Felix^a

^a Department of Radiology, University of Geneva, Switzerland
^b Department of Neuropathology, University of Geneva, Switzerland
^c Department of General Surgery, University of Geneva, Switzerland
^d Department of Charité, Campus Virchow Clinic, Berlin, Germany; School of Pharmacy, University of Geneva, Switzerland
^e Department of Angström Laboratory, Polymer Chemistry, University of Uppsala, Sweden
^f Department of Neuroradiology Section, University Hospital of Geneva, Switzerland

Address correspondence to Oliver Dudeck, MD, Department of Radiology, Charité, Campus Virchow Clinic, Augustenburger Platz, Berlin, Germany; e-mail: oliver.dudeck{at}charite.de

BACKGROUND AND PURPOSE: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.