Combination of Alcohol and EVOH as a New Embolic Agent: Midterm Tissue and Inflammatory Effects in a Swine Model

Abstract

Objective. To evaluate the vascular occlusion and midterm tissue toxicity properties of a combination of ethylene-vinyl alcohol (EVOH) (Squid 18®) (75%) and alcohol (25%)—Alco-Squid 18—in a swine model. Materials and Methods. Alco-Squid 18 (75% Squid 18® mixed with 25% alcohol) (AS18) was compared to embolization with 96% alcohol alone and to embolization with Squid 18® (S18®) alone. An arteriovenous malformation (AVM) model was created in group 1 (n = 2). Each AVM model was then embolized with AS18 or S18® alone with evaluation of a ratio between the volume of embolic agent divided by the volume of the AVM (evaluated by CT). For group 2 (n = 5), each agent was tested on three different kidneys (upper pole kidney artery). Pre- and postinterventional CTs, angiographies, blood alcohol content dosages, and histological studies (3 months postintervention) were performed. Results. AS18 has better distal distribution than S18® alone, both in the kidneys (mean capsule-S18® distance: 3.9 mm (±0.23) and mean capsule-AS18 distance: 2.3 mm (±0.11) ( p = 0.029 ) and in the AVM model. Histological exploration found a higher rate of tubular necrosis with AS18 compared with S18® alone and alcohol alone (3.78 ± 0.44 compared to 2.33 ± 1.22 p = 0 . 012 and 1.22 ± 0.67 p < 0 . 0001 ). The blood alcohol content was negligible in all cases. Conclusion. AS18 can suggest a better distal sclerotic and embolic character as compared with S18® alone without systemic toxicity.

Study of Safety and Efficacy of Endovascular Management of High-Flow Arteriovenous Malformation

“…Alcohol's low viscosity and limited visibility during systemic migration increase the likelihood of non-target embolization and other adverse consequences with a mortality rate reported of 0.6%. To be effective as an embolic liquid agent, a substance must have both sclerotic and embolic properties, without causing systemic toxicity (6) . One of the best-known examples of this is Onyx® (7) .…”