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Feasibility and Safety of n-Butyl Cyanoacrylate–Lipiodol–Iopamidol as an Alternative Liquid Embolic Material

  • Laboratory Investigation
  • Emblisation (arterial)
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the feasibility and safety of n-butyl cyanoacrylate (NBCA)–Lipiodol–Iopamidol (NLI) as a liquid embolic material.

Materials and Methods

In vitro, the ratio of NLI components was adjusted and the configuration of the mixtures was assessed visually in saline. In vivo, 14 wide-necked aneurysms were created on the common carotid and external iliac arteries of four female swine. Under balloon occlusion, 12 aneurysms were embolized with NLI prepared at a NBCA–Lipidol–Iopamidol ratio of 2:3:1 (NLI231), and two were embolized with NBCA–Lipiodol (NL) prepared at a NBCA–Lipiodol ratio of 1:2 (NL12) as a trial group. We performed angiography to evaluate the effectiveness of embolization and adhesion of the embolic material to the balloons or microcatheters.

Results

In vitro, NLI231 (33% NBCA) was considered to be the optimal ratio for aneurysm embolization based on its configuration and stability. In vivo, embolization using NLI231 was successful and no adhesion between the embolic material and the balloons or microcatheters was observed in all 12 aneurysms. Embolization with NL12 was impossible in the other two aneurysms due to leakage and adhesion of NL.

Conclusion

The configuration of NLI changed at each ratio. NLI231 is a feasible and safe liquid embolic material for balloon-assisted embolization of wide-necked aneurysms in swine.

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Abbreviations

NBCA:

n-Butyl cyanoacrylate

NL:

NBCA–Lipiodol

NLE:

NBCA–Lipiodol–ethanol

NLI:

NBCA–Lipiodol–Iopamidol

NL12:

NBCA–Lipiodol prepared at a ratio of 1:2

NLI231:

NBCA–Lipiodol–Iopamidol prepared at a ratio of 2:3:1

References

  1. Klein GE, Szolar DH, Karaic R, Stein JK, Hausegger KA, Schreyer HH. Extracranial aneurysm and arteriovenous fistula: embolization with the Guglielmi detachable coil. Radiology. 1996;201:489–94.

    Article  CAS  Google Scholar 

  2. Sildiroglu O, Saad WE, Hagspiel KD, Matsumoto AH, Turba UC. Endovascular management of iatrogenic native renal arterial pseudoaneurysms. Cardiovasc Intervent Radiol. 2012;35:1340–5.

    Article  Google Scholar 

  3. Buechner D, Lippuner V, DeMaio K, Donovan FD, Weber PR. Successful endovascular coil embolization of large pseudoaneurysm of ductus arteriosus diverticulum. CVIR Endovasc. 2019;2:12.

    Article  Google Scholar 

  4. Das JP, Asadi H, Kok HK, et al. Balloon-assisted coil embolization (BACE) of a wide-necked renal artery aneurysm using the intracranial scepter C compliant occlusion balloon catheter. CVIR Endovasc. 2018;1:12.

    Article  Google Scholar 

  5. Nagarajan K, Elango S, Ishita L, Shanmugam D. Traumatic pseudoaneurysm of the inferior mesenteric artery branch: a rare cause of lower gi bleeding and treatment with selective coil embolization. Cardiovasc Intervent Radiol. 2016;39:1358–60.

    Article  Google Scholar 

  6. Spiotta AM, Turner RD, Chaudry MI, et al. Carotid sacrifice with a single Penumbra occlusion device: a feasibility study in a swine model. J Neurointerv Surg. 2016;8:99–102.

    Article  Google Scholar 

  7. Sonomura T, Kawai N, Ikoma A, et al. Uterine damage in swine following uterine artery embolization: comparison among gelatin sponge particles and two concentrations of n-butyl cyanoacrylate. Jpn J Radiol. 2013;31:685–92.

    Article  CAS  Google Scholar 

  8. Yonemitsu T, Kawai N, Sato M, et al. 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. Cardiovasc Intervent Radiol. 2010;33:1192–7.

    Article  Google Scholar 

  9. Tamatani S, Ito Y, Koike T, et al. Efficacy of diluted NBCA mixture for embolization of arteriovenous malformations. Interv Neuroradiol. 1999;5:161–5.

    Article  Google Scholar 

  10. Li TL, Fang B, He XY, et al. Complication analysis of 469 brain arteriovenous malformations treated with n-butyl cyanoacrylate. Interv Neuroradiol. 2005;11:141–8.

    Article  CAS  Google Scholar 

  11. Toyoda H, Nakano S, Kumada T, et al. Estimation of n-butyl-2 cyanoacrylate-Lipiodol mixture in transcatheter arterial embolization for urgent control of life-threatening massive bleeding from gastric or duodenal ulcer. J Gastr Hepat. 1996;11:252–8.

    Article  CAS  Google Scholar 

  12. Kish JW, Katz MD, Marx MV, et al. n-Butyl cyanoacrylate embolization for control of acute arterial hemorrhage. J Vasc Interv Radiol. 2004;15:689–95.

    Article  Google Scholar 

  13. Hassan F, Younes A, Rifai M. Endovascular embolization of post-tonsillectomy pseudoaneurysm: a single-center case series. Cardiovasc Intervent Radiol. 2019;42:528–33.

    Article  CAS  Google Scholar 

  14. Tanaka T, Kawai N, Sato M, et al. Safety of bronchial arterial embolization with n-butyl cyanoacrylate in a swine model. World J Radiol. 2012;28:455–61.

    Article  Google Scholar 

  15. n-BCA Trail Investigators. n-Butyl cyanoacrylate embolization of cerebral arteriovenous malformations: results of a prospective, randomized, multi-center trial. AJNR Am J Neuroradiol. 2002;23:748–55.

    Google Scholar 

  16. Yamakado K, Nakatsuka A, Tanaka N, Takano K, Matsumura K, Takeda K. Transcatheter arterial embolization of ruptured pseudoaneurysms with coils and n-butyl cyanoacrylate. J Vasc Interv Radiol. 2000;11:66–72.

    Article  CAS  Google Scholar 

  17. Sugawara S, Arai Y, Sone M, et al. Phase II Trial of transarterial embolization using an n-butyl-2-cyanoacrylate/Lipiodol mixture (JIVROSG-0802). Cardiovasc Intervent Radiol. 2019;42:534–41.

    Article  Google Scholar 

  18. Debrun GM, Aletich VA, Shownkeen H, Ausman J. Glued catheters during embolisation of brain AVMs with acrylic glue. Interv Neuroradiol. 1997;30:13–9.

    Article  Google Scholar 

  19. Kawai N, Sato M, Minamiguchi H, et al. Basic study of a mixture of n-butyl cyanoacrylate, ethanol, and lipiodol as a new embolic material. J Vasc Interv Radiol. 2012;23:1516–21.

    Article  Google Scholar 

  20. Tanaka F, Kawai N, Sato M, et al. Effect of transcatheter arterial embolization with a mixture of n-butyl cyanoacrylate, lipiodol, and ethanol on the vascular wall: macroscopic and microscopic studies. Jpn J Radiol. 2015;33:404–9.

    Article  CAS  Google Scholar 

  21. Tanaka F, Kawai N, Sato M, et al. Balloon-assisted packing of wide-neck aneurysms with a mixture of n-butyl cyanoacrylate, Lipiodol, and ethanol: an experimental study. Jpn J Radiol. 2015;33:517–22.

    Article  CAS  Google Scholar 

  22. Hama M, Sonomura T, Ikoma A, et al. 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. Cardiovasc Intervent Radiol. 2020; https://doi.org/10.1007/s00270-020-02567-6.

  23. Nakai M, Ikoma A, Sato M, et al. Prophylactic intraoperative embolization of abdominal aortic aneurysm sacs using n-butyl-cyanoacrylate/Lipiodol/ethanol mixture with proximal neck aortic balloon occlusion during endovascular abdominal aortic repair. J Vasc Interv Radiol. 2016;27:954–60.

    Article  Google Scholar 

  24. Nakai M, Ikoma A, Higashino N, Inagaki T, Sonomura T. Balloon-occluded retrograde transvenous obliteration of a gastric varix with the use of an n-butyl cyanoacrylate-Lipiodol-ethanol mixture. J Vasc Interv Radiol. 2018;29:1325–7.

    Article  Google Scholar 

  25. Koizumi J, Sekiguchi T, Sekiguchi Y, et al. Embolization of congenital anastomosis between bronchial and pulmonary arteries using n-butyl cyanoacrylate combined with Lipiodol and ethanol under temporary balloon occlusion. J Vasc Interv Radiol. 2018;29:1321–3.

    Article  Google Scholar 

  26. Ikoma A, Nakai M, Loffroy R, et al. Transcatheter arterial embolization of a splenic artery aneurysm with n-butyl cyanoacrylate/Lipiodol/ethanol mixture with coil-assisted sandwich technique. Quant Imaging Med Surg. 2019;9:346–9.

    Article  Google Scholar 

  27. Nakai M, Ikoma A, Loffroy R, et al. Type II endoleak model creation and intraoperative aneurysmal sac embolization with n-butyl cyanoacrylate-lipiodol-ethanol mixture (NLE) in swine. Quant Imaging Med Surg. 2018;8(9):894–901.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Wakayama Medical University, Wakayama, 641-8509, Japan

    Nobuyuki Higashino M.D., Tetsuo Sonomura M.D., Ph.D., Kodai Fukuda M.D., Akira Ikoma M.D., Ph.D., Ryuta Okuhira M.D., Shota Ueda M.D. & Nobuyuki Kawai M.D., Ph.D.

Authors
  1. Nobuyuki Higashino M.D.
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  2. Tetsuo Sonomura M.D., Ph.D.
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  3. Kodai Fukuda M.D.
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  4. Akira Ikoma M.D., Ph.D.
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  5. Ryuta Okuhira M.D.
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  6. Shota Ueda M.D.
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  7. Nobuyuki Kawai M.D., Ph.D.
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Correspondence to Nobuyuki Higashino M.D..

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The authors declare that they have no conflicts of interest.

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All applicable international, national, and institutional guidelines for the care and use of animals were followed. And all procedures performed in this study involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted.

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Higashino, N., Sonomura, T., Fukuda, K. et al. Feasibility and Safety of n-Butyl Cyanoacrylate–Lipiodol–Iopamidol as an Alternative Liquid Embolic Material. Cardiovasc Intervent Radiol 44, 482–488 (2021). https://doi.org/10.1007/s00270-020-02681-5

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  • DOI: https://doi.org/10.1007/s00270-020-02681-5

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