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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 28:1191-1196, June-July 2007
DOI 10.3174/ajnr.A0536
© 2007 American Society of Neuroradiology

INTERVENTIONAL

Endovascular Embolization of the Swine Rete Mirabile with Eudragit-E 100 Polymer

H. Arakawa^a,d, Y. Murayama^d, C.R. Davis^c, D.L. Howard^a, W.L. Baumgardner^a, M.P. Marks^a,b and H.M. Do^a,b

^a Department of Radiology, Stanford University Medical Center, Stanford, Calif
^b Department of Neurosurgery, Stanford University Medical Center, Stanford, Calif
^c Department of Comparative Medicine, Stanford University Medical Center, Stanford, Calif
^d Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan

Please address correspondence to Hideki Arakawa, MD, Neurosurgery, Jikei University Hospital, 3-25-8 Nishi-shinbashi, Minatoku, Tokyo 104-8461, Japan; e-mail: harakawa{at}jikei.ac.jp, hidekiara{at}gmail.com

BACKGROUND AND PURPOSE: Both adhesive and nonabrasive embolic agents are available for arteriovenous malformation (AVM) embolization. The purpose of this study was to evaluate a novel ethanol-based nonadhesive liquid embolic material in a swine AVM model.

MATERIALS AND METHODS: Eudragit (copolymer of methyl and butyl methacrylate and dimethylaminoethyl methacrylate) was dissolved in 50% ethanol and 50% iopamidol. Eudragit was injected into 9 retia mirabilia (RMs). Ethanol and iopamidol mixture were injected into 4 RMs for comparison. Three RMs embolized with Eudragit mixture were evaluated both angiographically and histopathologically acutely (3–24 hours) and at 30 days and 90 days after embolization.

RESULTS: No procedural complications from Eudragrit embolization were noted, including retention or adhesion of the microcatheter. Various degrees of inflammation were observed in the acute and 30-day specimens. Two RMs showed partial recanalization on both histopathology and follow-up angiography in the 30-day group. Arterial fibrosis and calcification were observed in the 30- and 90-day specimens. The internal elastic lamina was disrupted in the 30- and 90-day specimens, but there was no evidence of Eudragit extravasation or hemorrhage. Endothelial damage was seen in all specimens and was particularly severe in the 30- and 90-day specimens.

CONCLUSION: Eudragit polymer induced inflammation in thrombosis similar to n-butyl 2-cyanoacrylate, but without the disadvantages of perivascular hemorrhage and extravasation of embolization material. Although recanalization of some embolized RMs was noted, further investigation into Eudragit as a potentially useful embolic material for brain AVMs is warranted.

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