Balloon-Assisted Embolization of Wide-Neck Aneurysms Using a Mixture of n-Butyl Cyanoacrylate, Lipiodol, and Ethanol in Swine: A Comparison of Four n-Butyl Cyanoacrylate Concentrations

Hama, Mizuki; Sonomura, Tetsuo; Ikoma, Akira; Koike, Masataka; Kamisako, Atsufumi; Tanaka, Ryota; Koyama, Takao; Sato, Hirotatsu; Tanaka, Fumihiro; Ueda, Shota; Okuhira, Ryuta; Warigaya, Kenji; Murata, Shin‐ichi; Nakaï, Motoki

doi:10.1007/s00270-020-02567-6

Cited by 12 publications

(9 citation statements)

References 16 publications

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“…Therefore, in this patient, it was deemed necessary to increase the NBCA concentration in the NBCA–Lipiodol mixture to prevent inflow into the common bile duct. However, in a prior study of aneurysms, it was reported that migration was less likely to occur if the NBCA concentration was ≥30% ( 10 ). In other words, if the concentration of NBCA exceeds 30%, polymerization of NBCA can be too fast or too hard ( 11 , 12 ).…”

Section: Discussionmentioning

confidence: 99%

Transcatheter arterial embolization using n-butyl cyanoacrylate–Lipiodol mixture and metallic coils in a patient with biliary hemorrhage after removing a bile duct metallic stent: a case description

Higashino¹,

Sonomura²,

Okuhira³

et al. 2022

Quant Imaging Med Surg

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Section: Discussionmentioning

confidence: 99%

Transcatheter arterial embolization using n-butyl cyanoacrylate–Lipiodol mixture and metallic coils in a patient with biliary hemorrhage after removing a bile duct metallic stent: a case description

Higashino¹,

Sonomura²,

Okuhira³

et al. 2022

Quant Imaging Med Surg

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“…NLE may be useful for isolating and occluding an arterial lesion previously occluded by a balloon. For instance, the decreased adhesiveness allows balloon-assisted glue packing of wide-neck aneurysms [ 59 , 65 , 66 ]. Injected NLE becomes nearly solid, thereby producing highly effective aneurysmal occlusion.…”

Section: Perspectives and Future Directionsmentioning

confidence: 99%

“…Ethanol may increase the durability of the occlusion notably by promoting thrombogenesis in the aneurysm. According to another swine study, which used various NLE ratios, ethanol may act synergistically with NBCA-Lipiodol ® to promote sac occlusion and endothelium destruction, thereby preventing sac recanalization [ 65 ]. NBCA concentrations of at least 30% were required to avoid NLE migration.…”

Section: Perspectives and Future Directionsmentioning

confidence: 99%

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Endovascular Use of Cyanoacrylate-Lipiodol Mixture for Peripheral Embolization: Properties, Techniques, Pitfalls, and Applications

Comby¹,

Guillen²,

Chevallier³

et al. 2021

JCM

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Endovascular embolization agents are particles and fluids that can be released into the bloodstream through a catheter to mechanically and/or biologically occlude a target vessel, either temporarily or permanently. Vascular embolization agents are available as solids, liquids, and suspensions. Although liquid adhesives (glues) have been used as embolic agents for decades, experience with them for peripheral applications is generally limited. Cyanoacrylates are the main liquid adhesives used for endovascular interventions and have a major role in managing vascular abnormalities, bleeding, and many vascular diseases. They can only be injected as a mixture with ethiodized oil, which provides radiopacity and modulates the polymerization rate. This review describes the characteristics, properties, mechanisms of action, modalities of use, and indications of the cyanoacrylate-Lipiodol® combination for peripheral embolization.

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“…The slower rate gives the operator more leeway, and the radiopacity of lipiodol enables fluoroscopic monitoring [ 19 ]. Anhydrous ethanol (AE) also delays endothelial adhesion by increasing interface polymerization and cohesive properties of NBCA [ 20 , 21 ]. Glubran ® 2 (GEM, Viareggio, Italy) is NBCA combined with the monomer metacryloxysulfolane (MS) to improve stability and decrease the in vivo exothermic reaction.…”

Section: Introductionmentioning

confidence: 99%

X-ray Microtomography to Assess Determinants of In Vivo N-Butyl Cyanoacrylate Glubran®2 Polymerization: A Rabbit-Model Study

et al. 2022

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Although introduced decades ago, few cyanoacrylate glues have been approved for endovascular use, despite evidence of their usefulness, notably for complex procedures suchas hemostatic embolization. Indications include massive bleeding requiring emergent hemostasis and prevention of severe bleeding during scheduled surgery to remove a hypervascular tumor. Adding radiopaque Lipiodol Ultra Fluid® (LUF) modulates glue polymerization and allows fluoroscopic guidance, but few comparative in vivo studies have assessed the impact of the resulting change in glue concentration or of other factors such as target-vessel blood flow. In a rabbit model, we used ex vivo X-ray microtomography to assess the results of in vivo renal-artery embolization by various mixtures of N-butyl cyanoacrylate (NBCA), metacryloxysulfolane, and LUF. Overall, penetration to the superficial interlobular arteries was achieved in about two-thirds of cases and into the capillaries in nearly half the cases, while cast fragmentation was seen in slightly more than half the cases. Greater NBCA dilution and the blocked-blood-flow technique were independently associated with greater distality of penetration. Blocked-blood-flow injection was independently associated with absence of fragmentation, capillary penetration, a shorter cast-to-capsule distance, and higher cast attenuation. A larger mixture volume was independently associated with higher indexed cast ratio and deeper penetration. Finally, microtomography is an adapted tool to assess ex vivo distribution of glue cast.

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Balloon-Assisted Embolization of Wide-Neck Aneurysms Using a Mixture of n-Butyl Cyanoacrylate, Lipiodol, and Ethanol in Swine: A Comparison of Four n-Butyl Cyanoacrylate Concentrations

Cited by 12 publications

References 16 publications

Transcatheter arterial embolization using n-butyl cyanoacrylate–Lipiodol mixture and metallic coils in a patient with biliary hemorrhage after removing a bile duct metallic stent: a case description

Transcatheter arterial embolization using n-butyl cyanoacrylate–Lipiodol mixture and metallic coils in a patient with biliary hemorrhage after removing a bile duct metallic stent: a case description

Endovascular Use of Cyanoacrylate-Lipiodol Mixture for Peripheral Embolization: Properties, Techniques, Pitfalls, and Applications

X-ray Microtomography to Assess Determinants of In Vivo N-Butyl Cyanoacrylate Glubran®2 Polymerization: A Rabbit-Model Study

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