Abstract
Objective To evaluate the vascular occlusion and midterm tissue toxicity properties of a combination of ethylene-vinyl alcohol (EVOH) (Squid 18®) (75%) and alcohol (25%)—Alco-Squid 18—in a swine model. Materials and Methods Alco-Squid 18 (75% Squid 18® mixed with 25% alcohol) (AS18) was compared to embolization with 96% alcohol alone and to embolization with Squid 18® (S18®) alone. An arteriovenous malformation (AVM) model was created in group 1 (n = 2). Each AVM model was then embolized with AS18 or S18® alone with evaluation of a ratio between the volume of embolic agent divided by the volume of the AVM (evaluated by CT). For group 2 (n = 5), each agent was tested on three different kidneys (upper pole kidney artery). Pre- and postinterventional CTs, angiographies, blood alcohol content dosages, and histological studies (3 months postintervention) were performed. Results AS18 has better distal distribution than S18® alone, both in the kidneys (mean capsule-S18® distance: 3.9 mm (±0.23) and mean capsule-AS18 distance: 2.3 mm (±0.11) (p=0.029) and in the AVM model. Histological exploration found a higher rate of tubular necrosis with AS18 compared with S18® alone and alcohol alone (3.78 ± 0.44 compared to 2.33 ± 1.22 (p = 0.012) and 1.22 ± 0.67 (p < 0 .0001)). The blood alcohol content was negligible in all cases. Conclusion AS18 can suggest a better distal sclerotic and embolic character as compared with S18® alone without systemic toxicity.
Highlights
Each arteriovenous malformations (AVMs) model was ® ® embolized with Alco-Squid 18 (AS18) or Squid 18 (S18) alone with evaluation of a ratio between the volume of embolic agent divided by the volume of the ® AVM
® ® Squid and Onyx are liquid embolic agents (LEAs), respectively, manufactured by Balt (Balt, Gland, Switzerland) and Medtronic (Medtronic, Irvine, California, USA) which are effective in the treatment of cerebrovascular lesions, chronic aortic endoleaks, other organ lesions, and peripheral nonneurologic bleeding. ese are a mixture of ethylenevinyl alcohol copolymer (EVOH), dissolved in dimethyl sulfoxide (DMSO), with added micronized tantalum powder, making the mixture visible under fluoroscopy
digital subtraction angiography (DSA) were performed first (Visipaque 320 mg I/ml, GE), and embolization was performed through a DMSOcompatible microcatheter (Marathon; Covidien/ev3 Neurovascular, Irvine, CA) after selective microcatheterization
Summary
To evaluate the vascular occlusion and midterm tissue toxicity properties of a combination of ethylene-vinyl alcohol (EVOH) (Squid 18 ) (75%) and alcohol (25%)—Alco-Squid 18—in a swine model. ® Squid 18 mixed with 25% alcohol) (AS18) was compared to embolization with 96% alcohol alone and to embolization with Squid ® 18 (S18 ) alone. An arteriovenous malformation (AVM) model was created in group 1 (n 2). Each AVM model was ® ® embolized with AS18 or S18 alone with evaluation of a ratio between the volume of embolic agent divided by the volume of the ® AVM (evaluated by CT). Pre- and postinterventional CTs, angiographies, blood alcohol content dosages, and histological studies (3 months postintervention) were. AS18 has better distal distribution than S18 alone, both in the kidneys (mean capsule-S18 distance: 3.9 mm (±0.23) and mean capsule-AS18 distance: 2.3 mm (±0.11) (p 0.029) and in the AVM model. E blood alcohol content was negligible in all cases. ® better distal sclerotic and embolic character as compared with S18 alone without systemic toxicity
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