Albadawi Hassan, Altun Izzet, Hu Jingjie, Zhang Zefu, Panda Anshuman, Kim Han-Jun, Khademhosseini Ali, Oklu Rahmi
Minimally Invasive Therapeutics Laboratory Department of Vascular and Interventional Radiology Mayo Clinic Phoenix AZ 85054 USA.
Terasaki Institute for Biomedical Innovation Los Angeles CA 90024 USA.
Adv Sci (Weinh). 2020 Nov 30;8(1):2003327. doi: 10.1002/advs.202003327. eCollection 2020 Jan.
Endovascular embolization to treat vascular hemorrhage involves pushing coil-shaped metal wires into the artery repeatedly until they are densely packed to slow the blood flow and clot. However, coil embolization is associated with high rebleeding rates, unpredictable economics and, most importantly, they rely on the patient's ability to make a clot. These issues are exacerbated when the patient is anticoagulated or coagulopathic. A novel bioengineered tantalum-loaded nanocomposite hydrogel for gel embolic material (Ta-GEM) that can be rapidly delivered using clinical catheters for instant hemostasis regardless of the coagulopathic state is reported. Ta-GEM formulation is visible by most of the clinically available imaging modalities including ultrasound, computed tomography, magnetic resonance imaging, and fluoroscopy without significant artifact. In addition, Ta-GEM can be retrieved, allowing temporary vascular occlusion, and it can be used to rescue cases of failed coil embolization. Ta-GEM occlusion of first-order arteries such as the renal artery and iliac artery in a swine model is found to be safe and durable; by 28 days, 75% of the injected Ta-GEM in the arterial lumen is replaced by dense connective tissue. Altogether, this study demonstrates that Ta-GEM has many advantages over the current technologies and has potential applications in clinical practice.
血管内栓塞治疗血管出血是将螺旋状金属丝反复推送至动脉内,直至紧密填充以减缓血流并形成血栓。然而,线圈栓塞术存在再出血率高、费用难以预测等问题,最重要的是,其依赖患者形成血栓的能力。当患者正在接受抗凝治疗或存在凝血功能障碍时,这些问题会更加严重。本文报道了一种新型生物工程负载钽的纳米复合水凝胶凝胶栓塞材料(Ta-GEM),它可通过临床导管快速输送以实现即时止血,且不受凝血功能障碍状态的影响。Ta-GEM制剂可通过大多数临床可用的成像方式观察到,包括超声、计算机断层扫描、磁共振成像和荧光透视,且无明显伪影。此外,Ta-GEM可以取出,实现临时血管闭塞,还可用于挽救线圈栓塞失败的病例。在猪模型中,Ta-GEM对肾动脉和髂动脉等一级动脉的闭塞被发现是安全且持久的;到第28天时,动脉腔内75%的注入Ta-GEM被致密结缔组织取代。总之,本研究表明Ta-GEM相对于现有技术具有许多优势,在临床实践中具有潜在应用价值。