Arterial embolizations with microvascular plug in extracranial and intracranial districts: technical results

Abstract

MVP seems to be a safe embolizing device that interventional radiologists should consider when facing arterial embolization of both body and neuroarterial districts; the main advantage is related to MVP3 and MVP5 models that can be adopted for distal embolization thanks to the precise release through 0.027″ microcatheter.

MVP (Micro Vascular Plug®) embolization of severe renal hemorrhages after nephrostomic tube placement

“…The first use of MVP in the clinical practice has been reported in literature in 2014 (Pellerin et al 2014); since then, series concerning MVP embolization in multiple anatomical districts described successful results (Kleine et al 2015;Carlson et al 2017;Burkhardt et al 2018;Giurazza et al 2018;Pellerin et al 2014;Shwe et al 2014;See et al 2017;Boatta et al 2017;Conrad et al 2015;Ratnani et al 2019;Mahdjoub et al 2018;Duvnjak et al 2018;Bailey et al 2019, Barrett et al 2018Boudjemline 2017;Wang-Giuffre and Breinholt 2017;Sathanandam et al 2017a, b;Hao et al 2016;Chick et al 2017;Bhardwaj et al 2017). In neuroendovascular embolization procedures, its use has been successfully reported in intracranial aneurysms and acute hemorrhages (Kleine et al 2015;Carlson et al 2017;Burkhardt et al 2018;Giurazza et al 2018), high-flow carotid cavernous (Shwe et al 2014) and basilar arterio-venous fistula (See et al 2017), vein of Galen malformation (See et al 2017). On the other hand, in extraneurovascular embolization, its application has been reported with good clinical and technical outcomes in pulmonary arteriovenous malformations (Boatta et al 2017;Conrad et al 2015;Ratnani et al 2019;Mahdjoub et al 2018;Duvnjak et al 2018;Bailey et al 2019;Barrett et al 2018), in hepatic, genicular, epigastric a...…”

“…In neuroendovascular embolization procedures, its use has been successfully reported in intracranial aneurysms and acute hemorrhages (Kleine et al 2015;Carlson et al 2017;Burkhardt et al 2018;Giurazza et al 2018), high-flow carotid cavernous (Shwe et al 2014) and basilar arterio-venous fistula (See et al 2017), vein of Galen malformation (See et al 2017). On the other hand, in extraneurovascular embolization, its application has been reported with good clinical and technical outcomes in pulmonary arteriovenous malformations (Boatta et al 2017;Conrad et al 2015;Ratnani et al 2019;Mahdjoub et al 2018;Duvnjak et al 2018;Bailey et al 2019;Barrett et al 2018), in hepatic, genicular, epigastric and genicular arteries bleeding (Giurazza et al 2018) as well as in bleeding ectopic duodenal varix along with transjugular intrahepatic portosystemic shunt (Bhardwaj et al 2017). Some authors presented also safe and effective experiences in paediatric patients where the MVP has been choosen to treat congenital heart disease, as closure of patent ductus arteriosus closure, Blalock-Taussig shunt, veno-venous and coronary fistulas, (Boudjemline 2017;Wang-Giuffre and Breinholt 2017;Sathanandam et al 2017aSathanandam et al , 2017b and lifethreatening upper gastrointestinal bleeding (Hao et al 2016).…”

“…Concerning renal bleeding embolization with MVP, only one case has been described in literature (Giurazza et al 2018); the presented series focuses specifically on iatrogenic renal hemorrhages embolization; being the renal parenchima widely arterialized, the angiographic spectrum of vascular lesions includes vessel laceration with extraluminal blush, arterovenous or arterocaliceal fistulas and one or more pseudoaneurysms. The authors found the MVP particularly indicated in this anatomical district because the division branches of the renal artery present a straight course and so can properly receive the MVP; the preprocedural CT findings, confirmed by the diagnostic DSA, play a crucial role in the choice of the procedural strategy and orientate the embolizing agents adopted.…”

“…The MVP should not be considered as an alternative to coils; it is instead a device with different features that could be used apart from or together with coils as complementary agent for backward sealing (Giurazza et al 2018), as occurred in one patient in this series.…”

“…The MVP is a mechanical embolization device; it presents a self-expanding nitinol skeleton ovoid-shaped covered with a Polytetrafluoroethylene (PTFE) coating (Giurazza et al 2018).…”