Sadato A, Wakhloo A K, Hopkins L N
Toshiba Stroke Research Center, Department of Neurosurgery, State University of New York at Buffalo, USA.
Neurosurgery. 2000 Nov;47(5):1197-203; discussion 1204-5. doi: 10.1097/00006123-200011000-00037.
Cyanoacrylates are the most commonly used liquid embolic agents. For embolization of arteriovenous malformations, a mixture of a low concentration of n-butylcyanoacrylate (NBCA) and Ethiodol (Savage Laboratories, Melville, NY) has been recommended for deeper penetration of the nidus. Dilution of NBCA, however, might result in different degrees of tissue reaction and might influence the permanence of vessel occlusion, with an increased risk of vessel recanalization. We compared tissue reactions induced by different NBCA/Ethiodol mixtures and analyzed the permanence of their embolic effects.
NBCA was diluted with Ethiodol to prepare the following standard solutions: Mixture A, low concentration (NBCA/Ethiodol ratio of 20:80); Mixture B, high concentration (50:50). The study was designed in two parts, because tissue reactions after embolization are considered to be a combination of foreign body reactions to solidified material and reactions to the injured blood vessel. Foreign body reactions were studied by intramuscularly injecting both glue mixtures into the backs of 18 rats. Specimens were obtained at various times after implantation. Immunohistochemical analysis and esterase staining were used to detect macrophages and neutrophils, respectively. The densities of these inflammatory cells were calculated and statistically compared. To study the degree of vascular wall injury and the permanence of embolic effects, the renal arteries in 48 rabbits were embolized with NBCA Mixture A or B. Six specimens for each group were obtained at various times after embolization.
There was no significant difference in foreign body reactions between groups treated with Mixtures A and B, at any time. However, the macrophage density was larger for both groups at 3 months versus 3 days and for the group treated with Mixture B at 3 months versus 2 weeks. There was no difference in the degree of vessel wall injury. None of the embolized vessels demonstrated evidence of recanalization.
The low concentration of NBCA induced a tissue response similar to that of the high-concentration form. Embolized vessels exhibited no greater incidence of recanalization. Therefore, embolization of arteriovenous malformations with diluted NBCA may be safe.
氰基丙烯酸酯是最常用的液体栓塞剂。对于动静脉畸形的栓塞治疗，有人推荐使用低浓度的正丁基氰基丙烯酸酯（NBCA）与碘油（萨维奇实验室，纽约州梅尔维尔）的混合物，以便更深入地渗透到病灶中。然而，NBCA的稀释可能会导致不同程度的组织反应，并可能影响血管闭塞的持久性，增加血管再通的风险。我们比较了不同NBCA/碘油混合物引起的组织反应，并分析了它们栓塞效果的持久性。
用碘油稀释NBCA以制备以下标准溶液：混合物A，低浓度（NBCA/碘油比例为20:80）；混合物B，高浓度（50:50）。该研究分为两部分设计，因为栓塞后的组织反应被认为是对固化材料的异物反应和对受损血管的反应的组合。通过将两种胶水混合物肌肉注射到18只大鼠的背部来研究异物反应。在植入后的不同时间获取标本。分别使用免疫组织化学分析和酯酶染色来检测巨噬细胞和中性粒细胞。计算这些炎性细胞的密度并进行统计学比较。为了研究血管壁损伤程度和栓塞效果的持久性，用NBCA混合物A或B栓塞48只兔子的肾动脉。栓塞后在不同时间每组获取6个标本。
在任何时间，用混合物A和B治疗的组之间异物反应没有显著差异。然而，两组在3个月时的巨噬细胞密度均大于3天时，且混合物B治疗组在3个月时大于2周时。血管壁损伤程度没有差异。所有栓塞血管均未显示再通迹象。
低浓度的NBCA引起的组织反应与高浓度形式相似。栓塞血管的再通发生率没有更高。因此，用稀释的NBCA栓塞动静脉畸形可能是安全的。
