Abstract
This review is devoted to an analysis of published data on liquid embolization agents based on polymers. Registered and employed brands of such agents as Onyx™, PHIL™, and Squid, as well as the less common Easyx™ and Menox™, are described. Data on their composition, properties, and application areas are given. Advantages and drawbacks of the described embolization drugs are discussed.
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REFERENCES
V. N. Dan, Angiodysplasias (Congenital Vascular Malformations) (Verdana, Moscow, 2008) [in Russian].
P. Chabrot, Embolization (Springer, 2013).
J. A. Goode and M. B. Matson, “Embolisation of cancer: What is the evidence?,” Cancer Imaging 4 (2), 133–141 (2004).
V. N. Dan, S. V. Sapelkin, O. A. Legonkova, V. N. Tsygankov, A. B. Varava, S. A. Kedik, and E. S. Zhavoronok, “Materials and methods of arteriovenous malformations' endovascular treatment: Opportunities and problems,” Vopr. Biol., Med. Farm. Khim., No. 7, 49–52 (2016).
W. S. Rilling and G. W. Chen, “Preoperative Embolization,” Semin. Interv. Radiol. 21 (1), 3–9 (2004).
A. A. Alluhaybi, S. B. Abdulqader, K. Altuhayni et al., “Preoperative trans-arterial embolization of a giant scalp congenial hemangioma associated with cardiac failure in a premature newborn,” J. Int. Med. Res. 48 (12), 1–7 (2020).
D. E. Orron, A. I. Bloom, and Z. Neeman, “The role of transcatheter arterial embolization in the management of nonvariceal upper gastrointestinal bleeding,” Gastrointest. Endosc. Clin. N. Am. 28 (3), 331–349 (2018).
M. B. Potts, D. W. Zumofen, E. Raz, et al., “Curing arteriovenous malformations using embolization,” Neurosurg. Focus 37 (3), E19 (2014).
www.accessdata.fda.gov/cdrh_docs/pdf3/P030004c.pdf. Cited January 21, 2021.
A. Poursaid, M. M. Jensen, E. Huo, et al., “Polymeric materials for embolic and chemoembolic applications,” J. Control. Release 240, 414–433 (2016).
J. Lord, H. Britton, S. G. Spain, et al., “Advancements in the development on new liquid embolic agents for use in therapeutic embolization,” J. Mater. Chem. 2020 (8), 8207–8218.
W. F. Yakes, J. M. Luethke, S. H. Parker, et al., “Ethanol embolization of vascular malformations,” Radio Graphics 10 (5), 787–796 (1990).
W. Taki, Y. Yonekawa, H. Iwata, et al., “A new liquid material for embolization of arteriovenous malformations,” Am. J. Neuroradiol. 11 (1), 163–168 (1990).
S. N. Tcherbinin, E. V. Tokareva, and S. K. Yarovoi, “Radiopaque contrast agents in urological practice,” Eksp. Klin. Urol., No. 4, 63–65 (2010).
M. Ayad, E. Eskioglu, and R. Mericle, “Onyx®: A unique neuroembolic agent,” Expert Rev. Med. Devices 3 (6), 705–715 (2006).
https://global.medtronic.com/xg-en/healthcare-professionals/products/cardiovascular/peripheral-embolization/onyx.html. Cited January 21, 2021.
D. F. Vollherbst, C. M. Sommer, C. Ulfert, J. Pfaff, et al., “Liquid embolic agents for endovascular embolization: Evaluation of an established (Onyx) and a novel (PHIL™) embolic agent in an in vitro AVM model,” Am. J. Neuroradiol. 38 (7), 1377–1382 (2017).
P. Gore, N. Theodore, L. Brasiliense, et al., “The utility of onyx for preoperative embolization of cranial and spinal tumors,” Neurosurgery 62 (6), 1204–1212 (2008).
M. S. Elhammady, E. C. Peterson, J. N. Johnson, et al., “Preoperative Onyx embolization of vascular head and neck tumors by direct puncture,” World Neurosurg. 77 (5) (2012).
W. Weber, B. Kis, R. Siekmann, and D. Kuehne, “Endovascular treatment of intracranial arteriovenous malformations with Onyx: Technical aspects,” Am. J. Neuroradiol. 28 (2), 371–377 (2007).
J. D. Rabinov, A. J. Yoo, C. S. Ogilvy, et al., “ONYX versus n-BCA for embolization of cranial dural arteriovenous fistulas,” J. Neurointerv. Surg. 5 (4), 306–310 (2012).
J. Urbano, Cabrera J. Manuel, A. Franco, et al., “Selective arterial embolization with ethylene-vinyl alcohol copolymer for control of massive lower gastrointestinal bleeding: feasibility and initial experience,” J. Vasc. Interv. Radiol. 25 (6), 839–846 (2014).
M. Szajner, T. Roman, J. Markowicz, et al., “Onyx® in endovascular treatment of cerebral arteriovenous malformations—a review,” Pol. J. Radiol. 78 (3), 35–41 (2013).
L. D. Codina, M. M. Crisol, A. G. Castel, et al., EU Patent No. 3653656 (May 20, 2020).
J. K. Aronson, Meyler’s Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions, 16th ed. (Elsevier, Amsterdam, 2015).
B. K. Madsen, M. Hilscher, D. Zetner, et al., “Adverse reactions of dimethyl sulfoxide in humans: A systematic review,” F1000Research 7, 1746 (2019).
C. F. Brayton, “Dimethyl sulfoxide (DMSO): A review,” Cornell Vet. 76 (1), 61–90 (1986).
M. Guimaraes and M. Wooster, “Onyx (ethylene-vinyl alcohol copolymer) in peripheral applications,” Semin. Interv. Radiol. 23 (3), 350–356 (2011).
R. Pop, L. Mertz, A. Ilyes, et al., “Beam hardening artifacts of liquid embolic agents: Comparison between squid and onyx,” J. Neurointerv. Surg. 11 (7), 706–709 (2018).
www.merillife.com/assets/pdfs/medical-devices/menox-1603358656pdf.pdf. Cited January 21, 2021.
Y. Loh and G. R. Duckwiler, “A prospective, multicenter, randomized trial of the onyx liquid embolic system and n-butyl cyanoacrylate embolization of cerebral arteriovenous malformations,” J. Neurosurg. 113 (4), 733–741 (2010).
I. Akmangit, E. Daglioglu, et al., “Preliminary experience with squid: A new liquid embolizing agent for AVM, AV fistulas and tumors,” Turk. Neurosurg. 24 (4), 565–570 (2014).
https://baltspainmedical.es/wp-content/uploads/2019/06/ SQUIDPERI-cat%C3%A1logo.pdf. Cited January 21, 2021.
J. Mason, C. Dodge, and G. Benndorf, “Quantification of tantalum sedimentation rates in liquid embolic agents,” Interv. Neuroradiol. 24 (5), 574–579 (2018).
“New liquid embolic agents, Squidperi 34 and 34LD, get CE mark,” Interv. News 69, 12 (2018).
E. Lozupone, S. Bracco, P. Trombatore, et al., “Endovascular treatment of cerebral dural arteriovenous fistulas with SQUID 12,” Interv. Neuroradiol. 26 (5), 651–657 (2020).
C. Perez-Garcia, S. Rosati, F. J. Serrano-Hernando, et al., “Preoperative squid embolization of carotid paragangliomas with direct puncture,” Neuroradiol. J. 33 (3), 224–229 (2020).
M. Venturini, L. Augello, C. Lanza, et al., “Emergency tips recanalisation and gastroesophageal varices embolisation with an ethylene vinyl alcohol copolymer agent (Squid) and detachable coils,” Eur. Radiol. Experimen. 4 (1), 67 (2020).
Salik A. Erbahceci, F. Islim, A. Akgul, and B. E. Cil, “Concomitant transarterial and transvenous embolization of a pelvic arteriovenous malformation using a new liquid embolic agent, Squid-12 and detachable coils,” Case Rep. Vasc. Med. 2014, 972870 (2014).
M. Venturini, C. Lanza, P. Marra, et al., “Transcatheter embolization with Squid, combined with other embolic agents or alone, in different abdominal diseases: A single-center experience in 30 patients,” CVIR Endovasc. 2 (8), 2 (2019).
A. Prashar, S. Butt, and N. Shaida, “Introducing PHIL (precipitating hydrophobic injectable liquid)—a new embolic agent for the body interventional radiologist,” Diagn. Interv. Radiol. 26 (2), 140–142 (2020).
www.vingmed.se/wp-content/uploads/2013/10/PHIL-Brochure-Intl. pdf.pdf. Cited January 21, 2021.
D. F. Vollherbst, R. Otto, M. Hantz, et al., “Investigation of a new version of the liquid embolic agent PHIL with extra-low-viscosity in an endovascular embolization model,” Am. J. Neuroradiol. 39 (9), 1696–1702 (2018).
S. Lamin, H. S. Chew, S. Chavda, et al., “Embolization of intracranial dural arteriovenous fistulas using PHIL liquid embolic agent in 26 patients: A multicenter study,” Am. J. Neuroradiol. 38 (1), 127–131 (2016).
D. F. Vollherbst, R. Otto, T. Do, et al., “Imaging artifacts of Onyx and PHIL on conventional CT, cone-beam CT and MRI in an animal model,” Interv. Neuroradiol. 24 (6), 693–701 (2018).
J. Hu, H. Albadawi, B. W. Chong, A. R. Deipolyi, et al., “Advances in biomaterials and technologies for vascular embolization,” Adv. Mater. 31 (33) (2019).
S. S. Sirakov, A. Sirakov, K. Minkin, et al., “Initial experience with precipitating hydrophobic injectable liquid in cerebral arteriovenous malformations,” Interv. Neuroradiol. 25 (1), 58–65 (2019).
E. A. Samaniego, C. P. Derdeyn, M. Hayakawa, et al., “In vivo evaluation of the new PHIL low viscosity in a swine rete mirabile model,” Interv. Neuroradiol. 24 (6), 706–712 (2018).
Z. Kulcsar, A. Karol, P. W. Kronen, et al., “A novel, non-adhesive, precipitating liquid embolic implant with intrinsic radiopacity: Feasibility and safety animal study,” Eur. Radiol. 27 (3), 1248–1256 (2016).
S. Maudens, PhD Thesis (Universite de Geneve, Geneve, 2018).
https://clinicaltrials.gov/ct2/show/study/NCT03477149. Cited January 21, 2021.
https://meddev.bda.bg/en/md_details/50804. Cited January 26, 2021.
S. Sirakov, A. Sirakov, K. Minkin, et al., “Initial experience with the new ethylene vinyl alcohol copolymer based liquid embolic agent menox in the endovascular treatment of cerebral arteriovenous malformations,” J. Neurointerv. Sur. 11 (10), 1040–1044 (2019).
A. Sirakov, K. Minkin, and S. Sirakov, “Intermixed dimethyl-sulfoxide-based nonadhesive liquid embolic agents delivered serially via the same microcatheter for cerebral AVM treatment,” Am. J. Neuroradiol. 44 (4), 681–686 (2020).
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Reshetnyak, D.V., Zhavoronok, E.S., Legon’kova, O.A. et al. Modern Liquid Embolization Agents Based on Polymers: Composition, Characteristics, and Areas of Application. Review. Polym. Sci. Ser. D 15, 64–70 (2022). https://doi.org/10.1134/S1995421222010154
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DOI: https://doi.org/10.1134/S1995421222010154