High-Concentration Ethylene-Vinyl Alcohol Copolymer and Endovascular Treatment of Experimental Aneurysms: Feasibility of Embolization without Protection Devices at the Neck
Jean Raymonda,b,
Igor Salazkinb,
Annick Metcalfeb,
François Guilberta,
Alain Weilla and
Daniel Roya
a Department of Radiology, Centre Hospitalier de l’Université de Montréal (CHUM), Notre-Dame Hospital, Montreal, Quebec, Canada
b Interventional Neuroradiology Research Laboratory, Research Center of CHUM, Montreal, Quebec, Canada
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FIG 1. HCEVOH embolization of aneurysms
Selected frames from angiographic monitoring of endovascular intervention show initial kernel formation (arrow, A), progressive enlargement of HCEVOH mass (B), final (C), and follow-up angiographic results at 3 months (D). Arrowheads in panel A indicate metallic markers on microcatheter. S indicates surgical clips at fundus of aneurysm. Note minimal neck remnant (arrow, D).
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FIG 2. Complication and recurrence with HCEVOH embolization
Selected frames from angiographic monitoring of procedure showing (A) stringing of HCEVOH and carotid embolization (arrows), excess HCEVOH protrusion (B, C), tearing of attached material (arrow, C) on catheter retrieval (D), and recurrence 3 months (arrows, F) after satisfactory occlusion of bifurcation aneurysm (E). The apparent residuum in panel E consists mostly of the bifurcation itself surgically constructed to obtain this morphology associated with a high incidence of recurrence (9).
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FIG 3. Macroscopic observations after HCEVOH embolization
Photography of specimens 3 months after embolization showing recurrence (A–C) or excess protrusion (D–F). Note complete neointima formation over HCEVOH (F) and recanalizing crescents in an example of recurrence (arrows, C).
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FIG 4. Neointima formation over HCEVOH
Macroscopic photography (A, C) and corresponding histopathologic sections (B, D) of neointima formation over HCEVOH at the neck of the aneurysm (A, B) or over an example of protrusion in the carotid artery (C, D). (B, D: Movat’s pentachrome stain; original magnification x200).
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FIG 5. Pathologic findings 3 months after HCEVOH embolization
Note complete replacement of aneurysmal sac with HCEVOH (A) and excellent neointima formation at the neck (B). Some tissue septations can be found within HCEVOH mass (C). A recanalizing crescent related to recurrence is shown in panel D (arrow). (A, D: Movat’s pentachrome stain; B, C: Hematoxylin Phloxin Saffron (HPS) stain; Original magnification: A, x100; B and D, x400, C, x200).
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