Comparison of Hemostatic Durability between N-Butyl Cyanoacrylate and Gelatin Sponge Particles in Transcatheter Arterial Embolization for Acute Arterial Hemorrhage in a Coagulopathic Condition in a Swine Model

Abstract

This study was designed to compare the efficacy of transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) or gelatin sponge particles (GSP) for acute arterial bleeding in a coagulopathic condition using a swine model. Four healthy swine were divided into two coagulopathic conditions: mild and severe. Five hemorrhages were created in each swine (10 hemorrhages per coagulopathy). Mild coagulopathy was achieved by bloodletting 10% of the total circulatory whole blood and preserving activated clotting time (ACT) less than 200 s (ACT < 200 s state); severe coagulopathy was achieved by bloodletting 30% and preserving ACT > 400 s (ACT > 400-second state). For each state, of ACT < 200 s or ACT > 400 s, TAE was conducted with GSP or NBCA to control five hemorrhages arising from artificially created renal and splenic injuries. Angiography immediately after TAE with GSP or NBCA showed complete occlusion in both coagulopathic conditions. In the ACT < 200-second state, follow-up angiography at 5-30 min after TAE with GSP or NBCA showed no evidence of recurrent hemorrhage. In the ACT > 400-second state, follow-up angiography showed recurrent hemorrhage in four (80%) of the five hemorrhages embolized with GSP and in one (20%) of the five hemorrhages embolized with NBCA. Microscopically, red thrombi were observed densely surrounding GSP in mild coagulopathy but were scarce in severe coagulopathy. In a condition with severe coagulopathy, TAE with NBCA was more effective in durability to cease active arterial bleeding than with GSP.

Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition

“…In addition, the operations were completed more quickly in the NBCA group (9 min ± 4) than in the microcoils group (37 min ± 19) or the gelatin sponge particle group (25 min ± 10) [185]. In a swine model-based experimental study comparing the hemostatic durability achieved by NBCA and gelatin sponge particles during transcatheter arterial embolization for acute arterial hemorrhaging in coagulopathic conditions (activated clotting time [ 400 s), follow-up angiography performed after the embolization procedure detected recurrent hemorrhaging in four (80 %) of the five hemorrhages that had been embolized with gelatin sponge particles, but only one (20 %) of the five hemorrhages that were embolized with NBCA [186].…”

Clinical Outcome of Transcatheter Arterial Embolization With N-Butyl-2-Cyanoacrylate for Control of Acute Gastrointestinal Tract Bleeding

“…NBCA is highly penetrable because of its liquid nature and is less affected by coagulopathies; thus, it may be used as an adjunct to other embolic materials to ensure the embolic effect [9,10]. However, NBCA is difficult to handle effectively and safely and is inherently more prone to cause ischemic necrosis.…”

Endovascular Treatment of Intractable Bleeding from a Traumatic Pseudoaneurysm of the Internal Maxillary Artery

“…The most common embolization materials were microcoils (ten patients, 40%), particles (seven patients, 28%), NBCA (six patients, 24%), and microcoils and particles (two patients, 8%). In patients receiving antiplatelet therapy or exhibiting a coagulopathic condition, it is most important to select the embolic materials for the control of acute hemorrhage 15,16 . Yonemitsu et al 15 reported the outcome of transcatheter arterial embolization with GSPs, microcoils, and NBCA for controlling acute arterial bleeding in a coagulopathic condition.…”

“…Endovascular embolization enables treatment via selective embolization and the achievement of adequate hemostasis in a coagulopathic condition or during antiplatelet therapy 15,16 .…”