Controlled myocardial infarction induced by intracoronary injection of n-butyl cyanoacrylatein dogs: A feasibility study

Abstract

Concentrated ethanol has been used to induce controlled myocardial infarct in patients with hypertrophic obstructive cardiomyopathy. We report the acute and early follow-up results of an alternative agent, n-butyl cyanoacrylate (n-BCA) glue, in a dog model. In 11 mongrel dogs, we injected n-BCA into different branches of the left anterior descending artery. Biplane left ventriculogram and coronary angiogram were performed before and after injection. In the surviving animals, we performed programmed stimulation (PS) to test for inducible ventricular tachycardia (VT) 48 days later. Following euthanasia, the removed hearts were studied with computer tomography (CT) and gross and histologic examination. Three dogs were lost before injection. Four dogs died within 2 hr to 4 days, and four animals survived 48 days. Accidental embolization of n-BCA into nontarget vessels was documented in four subjects. In the n-BCA-injected animals, homogeneous circumscribed scar was demonstrated by CT and histology. The glue was confined strictly to the tributary of the injected vessel, infiltrating arterioles of 14 mum. There was intense granulomatous reaction (GR) in the vessel wall and in the surrounding myocardium. Remote areas were unaffected. Monomorphic VT was not inducible with PS. We report a feasibility study of n-BCA injection to selected coronary arteries of dogs to cause controlled myocardial infarction. We demonstrated that the glue does not escape from the target artery through capillaries or small collateral vessels and thus produces a sharply demarcated and homogeneous scar, which is confined strictly to the supply zone of the injected vessel. Improvement of the delivery system is necessary to eliminate inadvertent embolization. Long-term follow-up is needed to study the GR induced by n-BCA.

Embozene™ microspheres induced nonreperfused myocardial infarction in an experimental swine model

“…Seven pigs, however, died during the postocclusion period. The mortality rate in this study (22.6%) was better than in some other closed‐chest models and was similar to other authors' experiences with coil embolization models .…”

“…Administration of liquids (ethanol, n ‐BCA, etc.) may cause accidental embolization into nontarget vessels due to the reflux of the agents . Among the techniques available to date, tungsten spiral embolization seems to be a promising method .…”

“…The methods for infarct generation described earlier can be classified into two, well‐defined approaches: (1) advancing a solid material into the coronary artery to create immediate occlusion or induce thrombus formation, or (2) flushing a liquid into the coronary artery generating tissue changes, thrombus formation, and consequent occlusion. Our method introduced here could be considered as a mixture of both.…”

“…Creating a closed‐chest, nonreperfused MI model requires special techniques and/or materials that allow advancing and leaving an item or substance in the coronary artery, providing a direct or indirect mechanical obstruction and usually a subsequent thrombus formation. Several techniques have been developed to model nonreperfused MI, e.g., inflatable‐detachable balloon occlusion ; flexible plug , open‐cell sponge , tungsten spiral , agarose gel bead , and microsphere (42 μm) embolization; ethanol , thrombin , and n ‐butyl cyanoacrylate ( n ‐BCA) injection . As many of those techniques have some shortcoming, in this study we introduce a new, easily applicable, cost effective, magnetic resonance imaging (MRI) compatible, nonreperfused MI model in pigs, using percutaneously administered Embozene™ microspheres.…”

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

“…Recommendation NBCA is mixed with contrast medium prior to its intravascular administration, because it is not visible under X-ray fluoroscopy [112]. Lipiodol or another oily contrast medium is usually used for this purpose (recommendation grade C1).…”