Endovascular Glue Embolization Research Articles

Efficacy of Endovascular Glue Embolization in Treating Ruptured Intracranial Mycotic Aneurysms: A Single Center Experience.

Intracranial mycotic aneurysms (IMAs), rare and often life-threatening, result from arterial wall infections typically caused by bacteria such as Staphylococcus and Streptococcus. The standard treatment for ruptured aneurysms is not well-defined and often individualized. This study investigates the efficacy of endovascular glue embolization in managing ruptured IMAs, based on our center's experience. A retrospective analysis was conducted for ruptured IMAs treated with glue embolization between January 2016 and December 2023. The procedure involved aneurysm sac and parent vessel occlusion with glue delivery. Data included patient demographics, clinical presentations, and neuroimaging. Clinical outcomes were assessed using the modified Rankin scale (mRS) at 3 months, and angiographic follow-up was conducted at 6 months. The study included 28 patients, predominantly male (64.3%), with a mean age of 48 years. Headache was the primary symptom in 92.9% of cases, and positive blood/cerebro spinal fluid cultures were found in 82.14% of cases. All aneurysms were located in the distal circulation, primarily in the anterior circulation system. Glue embolization was successfully performed in all cases, achieving complete aneurysm sac and parent vessel obliteration. Follow-up at 3 months indicated mRS scores of 0 or 1 in 96.5% of cases. Six-month angiographic follow-up showed no aneurysm regrowth or new formations. Endovascular glue embolization demonstrated high efficacy and safety in treating ruptured IMAs, with a 100% obliteration rate and favorable clinical outcomes in this single-center experience. Despite limitations such as its retrospective design and small sample size, the study supports glue embolization as a viable, less invasive alternative to traditional surgery. Further comparative studies are needed to confirm these findings and refine treatment approaches.

Endovascular Embolization of Spontaneously Ruptured Renal Artery Pseudoaneurysm in a Post-Partum Woman: A Case Report

Renal artery pseudoaneurysm (RAP) is a rare but potentially life-threatening condition that is often challenging to diagnose. While commonly associated with procedures or trauma, spontaneous cases are exceedingly rare. We present a case of a post-partum woman with a spontaneously ruptured segmental renal artery pseudoaneurysm. We report a 19-year-old post-partum woman presented with an enlarged kidney and rising serum creatinine levels following a caesarean section. Imaging revealed a ruptured renal artery pseudoaneurysm, and endovascular glue embolization was performed successfully.

Endovascular glue embolization of the medial posterior choroidal artery aneurysm: A case report and a literature review

Background: The medial posterior choroidal artery (MPCA) aneurysm is extremely uncommon. Thus yet, just a few cases have been reported. Due to the deep position, narrow lumen, fragile walls, and extensive tortuosity, both endovascular and microsurgical procedures are strictly limited. A case study of successful endovascular glue embolization of a left MPCA aneurysm and a literature review is included in this report. Case Description: A 17-year-old female arrived at our institution 2 days after suffering a major intraventricular hemorrhage with a minor subarachnoid hemorrhage. Digital subtraction angiography revealed a left MPCA aneurysm. The patient underwent a successful endovascular glue embolization and had a favorable functional outcome. Conclusion: Endovascular glue embolization yielded favorable clinical and angiographic results in MPCA aneurysms where microcatheter access and maneuverability are challenging.

Pseudoaneurysm of the profunda femoris artery following hip surgery

Pseudoaneurysm of the profunda femoris artery has been described as an iatrogenic phenomenon following orthopedic surgery. It may result due to trauma or direct arterial wall injury during dynamic hip screw fixation for proximal femur fracture. We present a case of a 65-year-old female who developed sudden pain and left thigh swelling one month after surgery for left sided intertrochanteric femur fracture. Computed tomography angiography of the left lower limb revealed the presence of a pseudoaneurysm in the upper left thigh. It was successfully treated with endovascular glue embolization followed by surgical excision of the pseudoaneurysm.

Intracranial pial arteriovenous malformation in an infant treated with endovascular glue embolization

Intracranial pial arteriovenous fistulas (AVFs) are rare vascular malformation in children. Children usually present with macrocrania and localized neurological impairments, whereas infants typically present with congestive heart failure. Congenital pial AVF may have syndromic association with Rendu-Osler-Weber disease and Klippel-Trenaunay-Weber syndrome. Here, we are reporting the case of a 5-month-old child who presented with multiple episodes of seizures and magnetic resonance imaging brain revealed pial AVF from the left middle cerebral artery. Following digital subtraction angiogram, glue embolization was done and achieved complete obliteration of venous sac and flow across fistula. Child had an uneventful postoperative period and developed no complications.

Raman Spectroscopic Characterization of Polymerization Kinetics of Cyanoacrylate Embolic Glues for Vascular Embolization.

Endovascular glue embolization is a minimally invasive technique used to selectively reduce or block the blood supply to specific targeted vessels. Cyanoacrylate glues, mixed with radiopaque iodized oil, have been widely used for vascular embolization owing to their rapid polymerization rate, good penetration ability and low tissue toxicity. Nevertheless, in clinical practice, the selection of the glue–oil proportion and the manual injection process of mixtures are mostly based on empirical knowledge of operators, as the crucial physicochemical effect of polymerization kinetics has rarely been quantitatively investigated. In this study, the Raman spectroscopy is used for studying the polymerization kinetics of n-butyl-cyanoacrylate-based glues mixed with an iodized oil. To simulate the polymerization process during embolization, glue–oil mixtures upon contact with a protein ionic solution mimicking blood plasma are manually constructed and their polymerization kinetics are systematically characterized by Raman spectroscopy. The results demonstrate the feasibility of Raman spectroscopy in the characterization of polymerization kinetics of cyanoacrylate-based embolic glues. The polymerization process of cyanoacrylate-based mixtures consists of a fast polymerization phase followed by a slow phase. The propagation velocity and polymerization time primarily depend on the glue concentrations. The commonly used 50% mixture polymerizes 1 mm over ∼21.8 s, while it takes ∼51 min to extend to 5 mm. The results provide essential information for interventional radiologists to help them understand the polymerization kinetics of embolic glues and thus regulate the polymerization rate for effective embolization.

Quantifying the Intra-Operative Hemodynamic Effects of Glue Embolization in Vein of Galen Malformations.

Vein of Galen malformation is a rare congenital pathological intracranial arteriovenous shunt which carries 30% risk of death before 28 days-of-age. Treatment is by high risk minimally invasive endovascular glue embolization of shunt feeding arteries under angiographic control. A tool to support intra-operative decision making would be useful. We present a novel method for visualizing angiography data to demonstrate the effect of the intervention based upon change the after embolization in the delay in time of peak contrast density relative to the injected artery and a novel method for quantifying the immediate effect of embolization on the hemodynamics of the shunt. The method is demonstrated on the angiograms of five neonates who underwent embolization. We show consistent results including a post-embolization increase in the delay in time of peak contrast density relative to the injected artery at the venous outflow in keeping with reduced shunting and redistribution of blood following embolization.

Endovascular glue embolization for control of massive hemoptysis caused by peripheral pulmonary artery pseudoaneurysms: Report of 7 cases.

Purpose:Pulmonary artery pseudoaneurysms are a rare cause of massive hemoptysis and need to be considered as a differential with prompt recognition preventing mortality from life-threatening hemorrhage. We report the clinical details and imaging findings for a series of patients presenting with massive haemoptysis due to peripheral pulmonary artery pseudoaneurysm, managed by endovascular glue embolization.Methods:Hospital based retrospective study wherein records and image database of patients presenting with massive hemoptysis between January 2014 and March 2016 were studied. The immediate technical success, reintervention rate, and recurrence of massive hemoptysis were recorded.Results:Among patients with massive hemoptysis who underwent endovascular management in our department, seven patients fulfilled the inclusion criteria. The mean age was 54.3 years; mean lesion diameter was 10.8 mm (range 6–14 mm); underlying pathology being infective (tuberculosis) in all cases (n = 7). All lesions were treated with endovascular glue embolization. The technical success was 100%. Mean follow-up was 11.7 months. There was no case of recurrence of massive hemoptysis. There were no major complications with a single case of minor complication (in the form of chest pain and discomfort) which resolved with medical management.Conclusion:The endovascular approach using glue (N-butyl cyanoacrylate) is a minimally invasive and technically feasible, effective technique for emergent management of pulmonary artery pseudoaneurysms presenting as massive hemoptysis.

A systematic characterization of the factors influencing polymerization and dynamic behavior of n-butyl cyanoacrylate

IntroductionBrain arteriovenous malformations are abnormal connections between arteries and veins without an intervening capillary bed. Endovascular glue embolization with N-butyl cyanoacrylate (NBCA) is an accepted form of treatment. The reported...

F.05 Characterization of NBCA glue polymerization for embolization of brain AVM’s

Background: Brain arteriovenous malformations (AVM’s) are abnormal connections between arteries and veins. Endovascular glue embolization with N-butyl cyanoacrylate (NBCA) is an accepted form of treatment, with most complications related to timing of polymerization. Current literature reports a wide range of polymerization times with large discrepancies between in-vivo and in-vitro results. Methods: Polymerization time was measured for mixtures of lipiodol/NBCA of 50/50, 60/40, 70/30. The influence of pH, temperature and presence of biological catalysts on polymerization rate was investigated in-vivo using submerged droplet tests. PVA-C, silicone and endothelium surfaces were compared and contact angles were measured to assess physical interaction with NBCA. High-speed video of glue injection through a microcatheter was captured to characterize coaxial flow. Results: Polymerization rate increases with pH and temperature. A hydrophilic substrate such as PVA-C provides surface properties that are most similar to endothelium. Endothelium provides a catalytic surface that increases the rate of polymerization. Blood products further increase the polymerization rate with RBC’s providing almost instantaneous polymerization of NBCA upon contact. Characterization of coaxial flow shows dripping to jetting transition with significant wall effect. Conclusions: We have successfully deconstructed and characterized the dynamic behavior of NBCA embolization. A refined understanding of NBCA behavior could help reduce embolization-related complications.

Fistule durale intracrânienne à drainage veineux périmédullaire : considérations anatomiques, cliniques et thérapeutiques à propos d’un cas, et revue de la littérature

Intracranial dural arteriovenous fistulae with perimedullary venous drainage are unusual type of vascular brain malformations. Patients may present with a rapidly progressive ascending myelopathy associated with autonomic dysfunction, which can cause a misdiagnosis and delay the therapeutic management. These clinical signs must be quickly recognized to avoid a poor outcome. The authors report the case of a 60-year-old woman presenting with a progressive myelopathy due to a dural arteriovenous fistula with perimedullary venous drainage. The diagnosis was suspected on brain-spinal MRI and confirmed by brain arteriography visualizing the arteriovenous shunt in the middle segment of the superior petrous sinus. MRI showed edema in the medulla oblongata. The treatment was performed early by endovascular glue embolization of the arteriovenous shunt and of the origin of the vein. Brain arteriography and clinical follow-up, one month later, showed complete disappearance of the dural fistula and regression of clinical symptoms. MRI control showed the reduction of the brain stem edema. Because of the early pejorative prognosis of these kinds of fistulae, early diagnosis and treatment are needed.

Anatomical Subcategorization for Pediatric Vein of Galen Aneurysmal Dilatation

Vein of Galen aneurysmal dilatation is generally considered an abnormal deep-seated arteriovenous shunt that drains into the Vein of Galen. We herein present three pediatric cases of vein of Galen aneurysmal dilatation (VGAD). The locations of these shunts are anatomically different from just parenchymal as previously reported, but are also cisternal and intraventricular. Clinical symptoms, neuroradiological diagnostic points and therapeutic endovascular management are reported. Three boys had abnormal findings on brain computed tomography. Using magnetic resonance images, magnetic resonance angiography, three dimensional computed tomographical angiography and digital subtraction angiography, these patients were diagnosed with VGAD. The different locations of their shunts were the intraventricular choroidal plexus, cistern verum interpositive, and thalamus pulvinar nucleus. The boy presenting a single hole arteriovenous shunt at the cistern verum interpositive and an arteriovenous malformation at the choroidal plexus in the left lateral ventricle were treated by endovascular glue embolization. The patient with a single hole fistula in the left thalamus was followed only with observation. Treated patients had their abnormal shunts closed without any neurological complications. VGADs should be classified by shunt location according to whether they are ventricular, cisternal, or parenchymal. Although the therapeutic decision for pediatric VGAD should consider individual radiological, clinical and familial factors, endovascular intervention should be chosen as a first therapeutic option. Endovascular management of these lesions result in excellent angiographic and clinical outcome.