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CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2022; 06(01): 010-014
DOI: 10.1055/s-0042-1746412
Review Article

Embolic Materials: Understanding the Ocean of Choices

Shamar Young
1   Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, United States
,
Anthony S. Larson
1   Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, United States
,
Pooya Torkian
1   Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, United States
,
Jafar Golzarian
1   Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, United States
› Author Affiliations Funding None.
› Further Information
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Abstract

Embolization is a fundamental procedure that interventional radiologists perform on a daily basis to treat a variety of diseases. The disease processes for which embolization is considered a safe and effective treatment are continuously expanding, as are the embolization materials available for use. To achieve optimal clinical outcomes and minimize complications, it is imperative that the interventional radiologist understands the properties, strengths, and weaknesses of each class of embolic and specific embolic products. This is a continuous process as new materials are always becoming available. This article reviews the different classes of embolic materials, discusses strengths and weaknesses, and reviews areas of innovation.

Keywords

embolic material - embolization - interventional - radiology

Note

The contents of this article, in whole or in part, have not been published or presented elsewhere.




Publication History

Article published online:
14 June 2022

© 2022. The Pan Arab Interventional Radiology Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Young S, Rostambeigi N, Golzarian J. The common but complicated tool: review of embolic materials for the interventional radiologist. Semin Intervent Radiol 2021; 38 (05) 535-541
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Young S, Craig P, Golzarian J. Current trends in the treatment of hepatocellular carcinoma with transarterial embolization: a cross-sectional survey of techniques. Eur Radiol 2019; 29 (06) 3287-3295
    CrossrefPubMedGoogle Scholar
  • 3 Young S, Golzarian J. Prostate artery embolization: state of the evidence and societal guidelines. Tech Vasc Interv Radiol 2020; 23 (03) 100695
    CrossrefPubMedGoogle Scholar
  • 4 Gasparetto A, Hunter D, Sapoval M, Sharma S, Golzarian J. Splenic embolization in trauma: results of a survey from an international cohort. Emerg Radiol 2021; 28 (05) 955-963
    CrossrefPubMedGoogle Scholar
  • 5 Hu J, Albadawi H, Chong BW. et al. Advances in biomaterials and technologies for vascular embolization. Adv Mater 2019; 31 (33) e1901071
    CrossrefPubMedGoogle Scholar
  • 6 White JB, Ken CGM, Cloft HJ, Kallmes DF. Coils in a nutshell: a review of coil physical properties. AJNR Am J Neuroradiol 2008; 29 (07) 1242-1246
    CrossrefPubMedGoogle Scholar
  • 7 Ahuja AA, Hergenrother RW, Strother CM, Rappe AA, Cooper SL, Graves VB. Platinum coil coatings to increase thrombogenicity: a preliminary study in rabbits. AJNR Am J Neuroradiol 1993; 14 (04) 794-798
    PubMedGoogle Scholar
  • 8 Liebig T, Henkes H, Fischer S. et al. Fibered electrolytically detachable platinum coils used for the endovascular treatment of intracranial aneurysms. Initial experiences and mid-term results in 474 aneurysms. Interv Neuroradiol 2004; 10 (01) 5-26
    CrossrefPubMedGoogle Scholar
  • 9 Girdhar G, Read M, Sohn J, Shah C, Shrivastava S. In-vitro thrombogenicity assessment of polymer filament modified and native platinum embolic coils. J Neurol Sci 2014; 339 (1-2): 97-101
    CrossrefPubMedGoogle Scholar
  • 10 Leyon JJ, Littlehales T, Rangarajan B, Hoey ET, Ganeshan A. Endovascular embolization: review of currently available embolization agents. Curr Probl Diagn Radiol 2014; 43 (01) 35-53
    CrossrefPubMedGoogle Scholar
  • 11 Grandhi R, Kottenmeier E, Cameron HL, Kane ST, Taussky P. Influence of neurovascular embolic coil primary wind diameter on aneurysm packing density and case costs. J Med Econ 2021; 24 (01) 345-351
    CrossrefPubMedGoogle Scholar
  • 12 Gaba RC, Ansari SA, Roy SS, Marden FA, Viana MA, Malisch TW. Embolization of intracranial aneurysms with hydrogel-coated coils versus inert platinum coils: effects on packing density, coil length and quantity, procedure performance, cost, length of hospital stay, and durability of therapy. Stroke 2006; 37 (06) 1443-1450
    CrossrefPubMedGoogle Scholar
  • 13 POD. Large volume systems. Accessed March 7, 2022 at: https://www.penumbrainc.com/peripheral-device/pod/
    Google Scholar
  • 14 Dudeck O, Bulla K, Wieners G. et al. Embolization of the gastroduodenal artery before selective internal radiotherapy: a prospectively randomized trial comparing standard pushable coils with fibered interlock detachable coils. Cardiovasc Intervent Radiol 2011; 34 (01) 74-80
    CrossrefPubMedGoogle Scholar
  • 15 Wang W, Li H, Tam MD, Zhou D, Wang DX, Spain J. The amplatzer vascular plug: a review of the device and its clinical applications. Cardiovasc Intervent Radiol 2012; 35 (04) 725-740
    CrossrefPubMedGoogle Scholar
  • 16 Lopera JE. The Amplatzer vascular plug: review of evolution and current applications. Semin Intervent Radiol 2015; 32 (04) 356-369
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Pech M, Kraetsch A, Wieners G. et al. Embolization of the gastroduodenal artery before selective internal radiotherapy: a prospectively randomized trial comparing platinum-fibered microcoils with the Amplatzer Vascular Plug II. Cardiovasc Intervent Radiol 2009; 32 (03) 455-461
    CrossrefPubMedGoogle Scholar
  • 18 Hart JL, Aldin Z, Braude P, Shovlin CL, Jackson J. Embolization of pulmonary arteriovenous malformations using the Amplatzer vascular plug: successful treatment of 69 consecutive patients. Eur Radiol 2010; 20 (11) 2663-2670
    CrossrefPubMedGoogle Scholar
  • 19 Giurazza F, Corvino F, Cavaglià E. et al. Arterial embolizations with microvascular plug in extracranial and intracranial districts: technical results. Radiol Med (Torino) 2018; 123 (03) 236-243
    CrossrefPubMedGoogle Scholar
  • 20 Jardinet T, Bonne L, Oyen R, Maleux G. Initial experience with the microvascular plug in selective renal artery embolization. Vasc Endovascular Surg 2020; 54 (03) 240-246
    CrossrefPubMedGoogle Scholar
  • 21 Ratnani R, Sutphin PD, Koshti V. et al. Retrospective comparison of pulmonary arteriovenous malformation embolization with the polytetrafluoroethylene-covered nitinol microvascular plug, AMPLATZER plug, and coils in patients with hereditary hemorrhagic telangiectasia. J Vasc Interv Radiol 2019; 30 (07) 1089-1097
    CrossrefPubMedGoogle Scholar
  • 22 Abdelsalam ME, Kappadath SC, Mahvash A. Blood flow diversion using the microvascular plug to avoid non target delivery of radioactive microspheres. Radiol Case Rep 2020; 15 (10) 2015-2017
    CrossrefPubMedGoogle Scholar
  • 23 Giurazza F, Ierardi AM, Contegiacomo A, Corvino F, Carrafiello G, Niola R. Embolization with MVP (Micro Vascular Plug®): experience on 104 patients in emergent and elective scenarios. CVIR Endovasc 2021; 4 (01) 59
    CrossrefPubMedGoogle Scholar
  • 24 Hughes P, Brennan I, Ryan JM. Use of the hourglass peripheral embolisation device: early experiences. Eur Radiol Exp 2018; 2 (01) 4
    CrossrefPubMedGoogle Scholar
  • 25 Endovascular today, Vascular plugs. Accessed March 7, 2022 at: https://evtoday.com/device-guide/european/vascular-plugs-1
    Google Scholar
  • 26 Jessen SL, Friedemann MC, Ginn-Hedman AM. et al. Microscopic assessment of healing and effectiveness of a foam-based peripheral occlusion device. ACS Biomater Sci Eng 2020; 6 (05) 2588-2599
    CrossrefPubMedGoogle Scholar
  • 27 Sheth RA, Sabir S, Krishnamurthy S. et al. Endovascular embolization by transcatheter delivery of particles: past, present, and future. J Funct Biomater 2017; 8 (02) 12
    CrossrefPubMedGoogle Scholar
  • 28 Golzarian J. Visibility and resorption: are these features important?. Cardiovasc Intervent Radiol 2021; 44 (02) 357-358
    CrossrefPubMedGoogle Scholar
  • 29 Abada HT, Golzarian J. Gelatine sponge particles: handling characteristics for endovascular use. Tech Vasc Interv Radiol 2007; 10 (04) 257-260
    CrossrefPubMedGoogle Scholar
  • 30 Doucet J, Kiri L, O'Connell K. et al. Advances in degradable embolic microspheres: a state of the art review. J Funct Biomater 2018; 9 (01) 14
    CrossrefPubMedGoogle Scholar
  • 31 Chua GC, Wilsher M, Young MPA, Manyonda I, Morgan R, Belli A-M. Comparison of particle penetration with non-spherical polyvinyl alcohol versus trisacryl gelatin microspheres in women undergoing premyomectomy uterine artery embolization. Clin Radiol 2005; 60 (01) 116-122
    CrossrefPubMedGoogle Scholar
  • 32 Pelage JP, Laurent A, Wassef M. et al. Uterine artery embolization in sheep: comparison of acute effects with polyvinyl alcohol particles and calibrated microspheres. Radiology 2002; 224 (02) 436-445
    CrossrefPubMedGoogle Scholar
  • 33 Khankan AA, Osuga K, Hori S, Morii E, Murakami T, Nakamura H. Embolic effects of superabsorbent polymer microspheres in rabbit renal model: comparison with tris-acryl gelatin microspheres and polyvinyl alcohol. Radiat Med 2004; 22 (06) 384-390
    PubMedGoogle Scholar
  • 34 Golzarian J, Lang E, Hovsepian D. et al. Higher rate of partial devascularization and clinical failure after uterine artery embolization for fibroids with spherical polyvinyl alcohol. Cardiovasc Intervent Radiol 2006; 29 (01) 1-3
    CrossrefPubMedGoogle Scholar
  • 35 Lewis AL, Gonzalez MV, Lloyd AW. et al. DC bead: in vitro characterization of a drug-delivery device for transarterial chemoembolization. J Vasc Interv Radiol 2006; 17 (2 Pt 1): 335-342
    CrossrefPubMedGoogle Scholar
  • 36 Fuchs K, Duran R, Denys A, Bize PE, Borchard G, Jordan O. Drug-eluting embolic microspheres for local drug delivery - state of the art. J Control Release 2017; 262: 127-138
    CrossrefPubMedGoogle Scholar
  • 37 Sommer CM, Do TD, Schlett CL. et al. In vivo characterization of a new type of biodegradable starch microsphere for transarterial embolization. J Biomater Appl 2018; 32 (07) 932-944
    CrossrefPubMedGoogle Scholar
  • 38 Stechele M, Wittgenstein H, Stolzenburg N. et al. Novel MR-visible, biodegradable microspheres for transcatheter arterial embolization: experimental study in a rabbit renal model. Cardiovasc Intervent Radiol 2020; 43 (10) 1515-1527
    CrossrefPubMedGoogle Scholar
  • 39 Young S, Gasparetto A, Golzarian J. Liquid embolics: a guide to currently available and pipeline products. Dig Dis Interv 2021; 46 DOI: 10.1055/s-0041-1740266.
    Article in Thieme ConnectGoogle Scholar
  • 40 Luz JHM, Luz PM, Bilhim T. et al. Portal vein embolization with n-butyl-cyanoacrylate through an ipsilateral approach before major hepatectomy: single center analysis of 50 consecutive patients. Cancer Imaging 2017; 17 (01) 25
    CrossrefPubMedGoogle Scholar
  • 41 Tamatani S, Koike T, Ito Y, Tanaka R. Embolization of arteriovenous malformation with diluted mixture of NBCA. Interv Neuroradiol 2000; 6 (1, Suppl 1) 187-190
    CrossrefPubMedGoogle Scholar
  • 42 Pollak JS, White Jr RI. The use of cyanoacrylate adhesives in peripheral embolization. J Vasc Interv Radiol 2001; 12 (08) 907-913
    CrossrefPubMedGoogle Scholar
  • 43 Seron A, Moine L, Laurent A. et al. An embolic gelling solution based on acrylic copolymers in ethanol for the treatment of arteriovenous malformations. Biomaterials 2009; 30 (20) 3436-3443
    CrossrefPubMedGoogle Scholar
  • 44 Bharadwaz A, Madhab G. Liquid embolization with onyx in a technically challenging case of acute upper GI bleeding. Indian J Surg 2013; 75 (Suppl. 01) 495-496
    CrossrefPubMedGoogle Scholar
  • 45 Urbano J, Manuel Cabrera J, Franco A, Alonso-Burgos A. Selective arterial embolization with ethylene-vinyl alcohol copolymer for control of massive lower gastrointestinal bleeding: feasibility and initial experience. J Vasc Interv Radiol 2014; 25 (06) 839-846
    CrossrefPubMedGoogle Scholar
  • 46 Né R, Chevallier O, Falvo N. et al. Embolization with ethylene vinyl alcohol copolymer (Onyx®) for peripheral hemostatic and non-hemostatic applications: a feasibility and safety study. Quant Imaging Med Surg 2018; 8 (03) 280-290
    CrossrefPubMedGoogle Scholar
  • 47 Jones AK, Dixon RG, Collins JD, Walser EM, Nikolic B. Society of Interventional Radiology Health and Safety Committee. Best practice guidelines for CT-guided interventional procedures. J Vasc Interv Radiol 2018; 29 (04) 518-519
    CrossrefPubMedGoogle Scholar
  • 48 Baba Y, Higashi M, Awai K. Minim invasive ther allied technol. Minim Invasive Ther Allied Technol 2018; 27 (01) 17-21
    PubMedGoogle Scholar
  • 49 Ganguli S, Lareau R, Jarrett T, Soulen MC. A water-based liquid embolic: evaluation of its safety and efficacy in a rabbit kidney model. J Vasc Interv Radiol 2021; 32 (06) 813-818
    CrossrefPubMedGoogle Scholar
  • 50 Lozupone E, Bracco S, Trombatore P. et al. Endovascular treatment of cerebral dural arteriovenous fistulas with SQUID 12. Interv Neuroradiol 2020; 26 (05) 651-657
    CrossrefPubMedGoogle Scholar
  • 51 Pedicelli A, Lozupone E, Valente I. et al. Pre-operative direct puncture embolization of head and neck hypervascular tumors using SQUID 12. Interv Neuroradiol 2020; 26 (03) 346-353
    CrossrefPubMedGoogle Scholar
  • 52 Schmitt N, Floca RO, Paech D. et al. Imaging artifacts of liquid embolic agents on conventional CT in an experimental in vitro model. Am J Neuroradiol 2021; 42 (01) 126-131
    CrossrefPubMedGoogle Scholar
  • 53 Vollherbst DF, Otto R, Do T. et al. Imaging artifacts of Onyx and PHIL on conventional CT, cone-beam CT and MRI in an animal model. Interv Neuroradiol 2018; 24 (06) 693-701
    CrossrefPubMedGoogle Scholar
  • 54 Vollherbst DF, Sommer CM, Ulfert C, Pfaff J, Bendszus M, Möhlenbruch MA. Liquid embolic agents for endovascular embolization: evaluation of an established (Onyx) and a novel (PHIL) embolic agent in an in vitro AVM model. AJNR Am J Neuroradiol 2017; 38 (07) 1377-1382
    CrossrefPubMedGoogle Scholar
  • 55 Koçer N, Hanımoğlu H, Batur Ş. et al. Preliminary experience with precipitating hydrophobic injectable liquid in brain arteriovenous malformations. Diagn Interv Radiol 2016; 22 (02) 184-189
    CrossrefPubMedGoogle Scholar
  • 56 Albadawi H, Altun I, Hu J. et al. Nanocomposite hydrogel with tantalum microparticles for rapid endovascular hemostasis. Adv Sci (Weinh) 2020; 8 (01) 2003327
    CrossrefPubMedGoogle Scholar