Blocked-flow vs. free-flow cyanoacrylate glue embolization: Histological differences in an in vivo rabbit renal artery model

IF 4.9 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Diagnostic and Interventional Imaging Pub Date : 2023-11-08 DOI:10.1016/j.diii.2023.10.003

Pierre-Olivier Comby , Kévin Guillen , Olivier Chevallier , Emilie Couloumy , Anne Dencausse , Philippe Robert , Sarah Catoen , Anne-Virginie Salsac , Serge Ludwig Aho-Glele , Romaric Loffroy

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Abstract

Purpose

The purpose of this in vivo animal study was to compare the acute histological effects on the arterial vessel wall of free-flow vs. blocked-flow embolization with metacryloxysulfolane-n‑butyl cyanoacrylate (MS-NBCA) in several concentrations.

Materials and methods

A total of 42 rabbit renal arteries were embolized using MS-NBCA mixed with ethiodized oil. The MS-NBCA concentration was 12.5%, 25%, or 50%. All mixtures were injected under both free-flow and blocked-flow conditions. The rabbits were euthanised 30 min after arterial embolization. Arterial-lumen distension, intimal inflammation and necrosis, peri‑arterial edema, and distality of MS-NBCA penetration were assessed histologically. Multivariable regression analyses were performed using a manual backward procedure, with linear, ordinal and logistic regression to search for factors associated with these outcomes

Results

Marked or severe dilatation was observed in 36 out of 42 arteries (86%) and marked or transmural intimal arteritis in all 42 arteries (42/42; 100%). Lumen dilatation caused focal vessel-wall flattening, which resulted in intimal necrosis. Multifocal necrosis extending from the intima to the media occurred in 23 out of 42 kidneys (55%) and peri‑arterial edema with multifocal vascular leakage in 19 out of 42 kidneys (45%). At multivariable analysis, blocked-flow MS-NBCA injection was associated with greater severity of vessel-wall lesions, including intimal arteritis (P = 0.003) and intimal necrosis (P = 0.014), compared to free-flow injection. Blocked-flow injection was also associated with peri‑arterial edema (P = 0.008) and greater distality of MS-NBCA penetration (P = 0.001).

Conclusion

Blocked-flow MS-NBCA injection during renal artery embolization is significantly associated with more acute arterial-wall damage and greater distality of glue penetration compared to free-flow injection in a rabbit model. These preliminary findings may have clinical implications, as blocked-flow injection is routinely used to treat specific vascular diseases or malformations in human.

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阻塞流与自由流氰基丙烯酸酯胶栓塞：活体兔肾动脉模型的组织学差异

目的本体内动物研究的目的是比较使用不同浓度的偏丙烯酰氧基硫醇-正丁基氰基丙烯酸酯（MS-NBCA）进行自由流动栓塞与阻塞流动栓塞对动脉血管壁的急性组织学影响。MS-NBCA 的浓度分别为 12.5%、25% 或 50%。所有混合物均在自由流动和阻塞流动条件下注射。兔子在动脉栓塞 30 分钟后被安乐死。对动脉管腔扩张、内膜炎症和坏死、动脉周围水肿以及 MS-NBCA 穿透距离进行组织学评估。结果在 42 条动脉中的 36 条（86%）观察到明显或严重的扩张，在所有 42 条动脉中观察到明显或透壁内膜动脉炎（42/42；100%）。管腔扩张导致局灶性血管壁变平，进而导致内膜坏死。42 个肾脏中有 23 个（55%）出现了从内膜延伸到中层的多灶性坏死，42 个肾脏中有 19 个（45%）出现了伴有多灶性血管渗漏的动脉周围水肿。在多变量分析中，与自由流注射相比，阻塞流 MS-NBCA 注射与更严重的血管壁病变有关，包括内膜动脉炎（P = 0.003）和内膜坏死（P = 0.014）。结论与兔模型中的自由流注射相比，肾动脉栓塞过程中的阻塞流 MS-NBCA 注射与更多的急性动脉壁损伤和更远的胶水渗透明显相关。这些初步研究结果可能具有临床意义，因为阻塞流注射是治疗人类特定血管疾病或畸形的常规方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diagnostic and Interventional Imaging Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

8.50

自引率

29.10%

发文量

126

审稿时长

11 days

期刊介绍： Diagnostic and Interventional Imaging accepts publications originating from any part of the world based only on their scientific merit. The Journal focuses on illustrated articles with great iconographic topics and aims at aiding sharpening clinical decision-making skills as well as following high research topics. All articles are published in English. Diagnostic and Interventional Imaging publishes editorials, technical notes, letters, original and review articles on abdominal, breast, cancer, cardiac, emergency, forensic medicine, head and neck, musculoskeletal, gastrointestinal, genitourinary, interventional, obstetric, pediatric, thoracic and vascular imaging, neuroradiology, nuclear medicine, as well as contrast material, computer developments, health policies and practice, and medical physics relevant to imaging.