Optimal combination of microcoils, flow control, and n-butyl cyanoacrylate-Lipiodol-iopamidol (2:3:1) for feasible embolization of medium-sized arteries in an in vitro vascular model.

Abstract

Purpose: To evaluate the behavior of n-butyl cyanoacrylate-Lipiodol-iopamidol at a ratio of 2:3:1 (NLI231) with and without microcoils and/or flow control in embolization of medium-sized arteries in an in vitro vascular model.

Materials and methods: A vessel model representing a common hepatic artery was prepared. Six scenarios were set for embolization, each ran three times: 1) NLI231 injected alone with flow control to 0 ml/min during and up to 5 min after embolization; 2) NLI231 injected into a mesh of microcoil of 5% density with the flow control; 3) NLI231 injected into a microcoil of 10% density with the flow control; 4) NLI231 injected alone without the flow control; 5) NLI231 injected into microcoil of 5% density without the flow control; 6) NLI231 injected into a microcoil of 10% density without the flow control. The microcoils were delivered to the embolization site, and NLI231 was injected. After 1 h of observation, distal filters were collected, and grades of migration (I = none, II = partial, III = almost all-all) were assessed for each scenario.

Results: Embolization was achieved in scenarios with NLI231 and microcoils regardless of flow control (p < 0.01). NLI231 did not migrate in scenarios with microcoils and flow control (p < 0.05). NLI231 with microcoils without flow control can embolize the vessel, but partial migration occurred, and the distal distance of the NLI231 complex from the embolization site was longer (p < 0.01).

Conclusion: Combining sparse coiling with NLI231 may be feasible but is limited to use when flow control is available, or where distal embolization is permissible to some extent.