Dudeck O, Jordan O, Hoffmann K T, Okuducu A F, Husmann I, Kreuzer-Nagy T, Tesmer K, Podrabsky P, Bruhn H, Hilborn J, Rüfenacht D A, Doelker E, Felix R
Department of Radiology, Charité, Campus Virchow Clinic, Berlin, Germany.
AJNR Am J Neuroradiol. 2006 Oct;27(9):1849-55.
To evaluate the ready-to-use iodine-containing polyvinyl alcohol (I-PVA) dissolved in the low angiotoxic solvent N-methyl pyrrolidone (NMP) for embolization of porcine wide-necked aneurysms.
Fourteen broad-based carotid sidewall aneurysms were surgically constructed in 7 swine. I-PVA (40%) in NMP was injected under temporary balloon occlusion bridging the aneurysm neck. After 4 weeks, follow-up angiography, multisection CT angiography (MSCTA), and 3T MR imaging including MR angiography (MRA) sequences were performed. Afterward, harvested aneurysms were investigated histopathologically.
The liquid embolic was well visible under fluoroscopy and displayed a favorable precipitation pattern, allowing for controlled polymer delivery. Ten aneurysms (71%) were initially completely occluded, whereas in 1 aneurysm, a minimal polymer leakage was observed. The other 4 aneurysms (29%) were almost completely occluded. One animal suffered a lethal rebleeding from the anastomosis after uneventful embolization. Aneurysms embolized with I-PVA could be discriminated well from the parent artery without beam-hardening artifacts on MSCTA, and no susceptibility artifacts were encountered on MR imaging. Histologic examination revealed all aneurysms covered with a membrane of fibroblasts and an endothelial cell layer while a moderate intraaneurysmal inflammatory response to the polymer was observed.
I-PVA dissolved in NMP has proved its effectiveness for the embolization of experimental wide-necked aneurysms. This precipitating liquid embolic offers several interesting features in that it needs no preparation before use and no radiopaque admixtures, the latter allowing for artifact-free evaluation of treated aneurysms with MSCTA and MRA. Moreover, it uses NMP as a solvent, which has only a low angiotoxicity.
评估溶解于低血管毒性溶剂N-甲基吡咯烷酮（NMP）中的即用型含碘聚乙烯醇（I-PVA）用于猪宽颈动脉瘤栓塞的效果。
在7头猪身上手术构建了14个宽基底颈动脉侧壁动脉瘤。在临时球囊阻断跨越瘤颈的情况下，注入NMP中的I-PVA（40%）。4周后，进行随访血管造影、多层面CT血管造影（MSCTA）以及包括磁共振血管造影（MRA）序列的3T磁共振成像。之后，对切除的动脉瘤进行组织病理学研究。
液体栓塞剂在荧光透视下清晰可见，并呈现出良好的沉淀模式，有利于控制聚合物的输送。10个动脉瘤（71%）最初完全闭塞，而在1个动脉瘤中观察到有少量聚合物渗漏。另外4个动脉瘤（29%）几乎完全闭塞。1只动物在栓塞过程顺利后，吻合口发生致命性再出血。用I-PVA栓塞的动脉瘤在MSCTA上可与母动脉很好地区分，且无束硬化伪影，在磁共振成像上也未遇到磁化率伪影。组织学检查显示，所有动脉瘤均覆盖有成纤维细胞膜和内皮细胞层，同时观察到对聚合物有中度的动脉瘤内炎症反应。
溶解于NMP中的I-PVA已证明其对实验性宽颈动脉瘤栓塞的有效性。这种沉淀型液体栓塞剂具有几个有趣的特点，即使用前无需准备且无需不透射线的添加剂，后者使得用MSCTA和MRA对治疗后的动脉瘤进行无伪影评估成为可能。此外，它使用NMP作为溶剂，其血管毒性较低。
