CardioVascular and Interventional Radiology, 2019, Vol.42(6), pp.905-914
Byline: Dominik F. Vollherbst (1,2), Thuy D. Do (2), Manfred Jugold (3), Viktoria Eichwald (3), Stephan Macher-Goppinger (4), Philippe L. Pereira (6), Martin Bendszus (1), Markus A. Mohlenbruch (1), Gotz M. Richter (5), Hans U. Kauczor (2), Christof M. Sommer (2,5) Keywords: Embolization; Liquid embolic; Ethibloc; Onyx; Histoacryl Abstract: Purpose To investigate the novel zein-based non-adhesive precipitating liquid embolic HEI.sub.E1_2017. Materials and Methods Zein-based liquid embolics are an own class of embolization material. In this study, HEI.sub.E1_2017, a novel zein-based liquid embolic, was investigated. Visibility was assessed in vitro in CT and MRI phantoms, embolization characteristics were assessed in vivo in the kidneys of 12 pigs. Components of HEI.sub.E1_2017 were zein as occlusion material, ethanol as solvent, and iodized oil as radiopaque material. HEI.sub.E1_2017 was used in pure (HEI-PURE) and manually modified (HEI-MOD) form and compared with 6% ethylene vinyl alcohol copolymer (EVOH). Different radiological methods (CT, MRI, DSA, cone-beam CT, and micro-CT) and histopathologic analyses were applied to compare visibility and vascular occlusion patterns. Results In CT phantoms, all embolics were definitely visible as hyperdense materials. In MRI phantoms, signal-to-noise ratio was highest for HEI-PURE, followed by HEI-MOD and EVOH. In all kidneys, embolization procedures were technically successful and without complications. In DSA, all embolics were definitely visible during and after embolization. Only EVOH caused substantial artifacts in cone-beam CT and CT. In micro-CT and histopathology, HEI-PURE showed a homogeneous occlusion from segmental arteries to glomerular capillaries. HEI-MOD demonstrated the deepest vascular penetration (up to the level of peritubular capillaries), but with an inhomogeneous distribution. For EVOH, there was inhomogeneous vascular occlusion from segmental arteries to glomerular capillaries. Conclusion HEI.sub.E1_2017 is a promising novel zein-based liquid embolic. Further preclinical and clinical studies with higher case numbers and long-term follow-up are needed to further assess the value of this embolic material. Author Affiliation: (1) 0000 0001 0328 4908, grid.5253.1, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (2) 0000 0001 0328 4908, grid.5253.1, Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, INF 110, 69120, Heidelberg, Germany (3) 0000 0004 0492 0584, grid.7497.d, German Cancer Research Center, Heidelberg, Germany (4) grid.410607.4, Institute of Pathology, Mainz University Hospital, Mainz, Germany (5) 0000 0001 0341 9964, grid.419842.2, Clinic of Diagnostic and Interventional Radiology, Klinikum Stuttgart, Stuttgart, Germany (6) 0000 0001 0142 7696, grid.492899.7, Clinic for Radiology, Minimally-invasive Therapies and Nuclear Medicine, SLK Kliniken Heilbronn GmbH, Heilbronn, Germany Article History: Registration Date: 02/02/2019 Received Date: 01/11/2018 Accepted Date: 02/02/2019 Online Date: 13/02/2019 Article note: Electronic supplementary material The online version of this article ( https://doi.org/10.1007/s00270-019-02179-9) contains supplementary material, which is available to authorized users.
Embolization ; Liquid embolic ; Ethibloc ; Onyx ; Histoacryl
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