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Keywords = N-butyl-cyanoacrylate embolization

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11 pages, 2541 KiB  
Article
Predicting Early Outcomes of Prostatic Artery Embolization Using n-Butyl Cyanoacrylate Liquid Embolic Agent: A Machine Learning Study
by Burak Berksu Ozkara, David Bamshad, Ramita Gowda, Mert Karabacak, Vivian Bishay, Kirema Garcia-Reyes, Ardeshir R. Rastinehad, Dan Shilo and Aaron Fischman
Diagnostics 2025, 15(11), 1351; https://doi.org/10.3390/diagnostics15111351 - 28 May 2025
Viewed by 478
Abstract
Background/Objectives: Prostatic artery embolization (PAE) has been increasingly recognized, especially with recent progress in embolization techniques for the management of lower urinary tract symptoms due to benign prostatic hyperplasia. Nevertheless, a proportion of patients undergoing PAE fail to demonstrate clinical improvement. Machine [...] Read more.
Background/Objectives: Prostatic artery embolization (PAE) has been increasingly recognized, especially with recent progress in embolization techniques for the management of lower urinary tract symptoms due to benign prostatic hyperplasia. Nevertheless, a proportion of patients undergoing PAE fail to demonstrate clinical improvement. Machine learning models have the potential to provide valuable prognostic insights for patients undergoing PAE. Methods: A retrospective cohort study was performed utilizing a modified prior-data fitted network architecture to predict short-term (7 weeks) favorable outcomes, defined as a reduction greater than 9 points in the International Prostate Symptom Score (IPSS), in patients who underwent PAE with nBCA glue. Patients were stratified into two groups based on the median IPSS reduction value, and a binary classification model was developed to predict the outcome of interest. The model was developed using clinical tabular data, including both pre-procedural and intra-procedural variables. SHapley Additive ExPlanations (SHAP) were used to uncover the relative importance of features. Results: The final cohort included 109 patients. The model achieved an accuracy of 0.676, an MCC of 0.363, a precision of 0.666, a recall of 0.856, an F1-score of 0.731, and a Brier score of 0.203, with an AUPRC of 0.851 and an AUROC of 0.821. SHAP analysis identified pre-PAE IPSS, prior therapy, right embolization volume, preoperative quality of life, and age as the top five most influential features. Conclusions: Our model showed promising discrimination and calibration in predicting early outcomes of PAE with nBCA glue, highlighting the potential of precision medicine to deliver interpretable, individualized risk assessments. Full article
(This article belongs to the Special Issue Artificial Intelligence for Health and Medicine)
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12 pages, 5893 KiB  
Article
Glue and Ethanol Mixture for Aneurysm Endovascular Treatment: Animal Lab Study, Imaging, and Histopathological Findings
by Massimo Muto, Giuseppe Leone, Flavio Giordano, Gianluigi Guarnieri, Antonio Di Donna, Vincenzo Andreone, Eva Di Maro, Alessandro Poli, Niccolò Fonti, Ferdinando Caranci and Mario Muto
J. Clin. Med. 2024, 13(23), 7222; https://doi.org/10.3390/jcm13237222 - 28 Nov 2024
Viewed by 3702
Abstract
Background: This study aims to investigate the degree of penetration, permanence of occlusion, and vascular changes induced by a newly modified mixture of n-butyl cyanoacrylate (Glubran 2®), ethanol, and Lipidol® (GEL) in the endovascular treatment of experimental aneurysms induced in [...] Read more.
Background: This study aims to investigate the degree of penetration, permanence of occlusion, and vascular changes induced by a newly modified mixture of n-butyl cyanoacrylate (Glubran 2®), ethanol, and Lipidol® (GEL) in the endovascular treatment of experimental aneurysms induced in swine. Methods: Bilateral pouch aneurysms were created in the wall of the internal carotid artery in eighteen pigs. The sixteen aneurysms were treated with a new mixture of GEL with different component proportions. Angiograms were obtained at the time of treatment and at 1, 4, and 16 weeks after treatment. According to the scheduled experimental design, subjects were sacrificed at the time of treatment and 7, 30, and 90 days after the embolization of experimentally induced aneurysms. The internal carotid artery and aneurysms were removed en bloc and sampled for histopathologic study. Results: The mixture induced complete and stable occlusion without recanalization in all experimentally induced aneurysms throughout the study period. Histopathological studies showed focal angionecrosis and acute inflammatory reactions from 7 dpi, followed by chronic inflammation and vessel wall thickening. Conclusions: The GEL mixture may be useful in future clinical applications for the embolization of arteriovenous malformations, the control of acute bleeding, and the isolation of aneurysms due to its very short polymerization time and minimal adhesion to the microcatheter. Full article
(This article belongs to the Special Issue Clinical Advances and Future Perspectives in Vascular Surgery)
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7 pages, 3347 KiB  
Case Report
Arterial Embolization with n-Butyl-Cyanoacrylate for a Large Gluteal Intramuscular Hemangioma: A Case Report
by Nicolas Papalexis, Michela Carta, Giuliano Peta, Simone Quarchioni, Maddalena Di Carlo, Marco Miceli and Giancarlo Facchini
Reports 2024, 7(4), 106; https://doi.org/10.3390/reports7040106 - 26 Nov 2024
Viewed by 1023
Abstract
Background and Clinical Significance: We wished to review the use of arterial embolization with n-butyl-cyanoacrylate (NBCA) to treat large high-flow vascular malformations due to its rapid polymerization and ability to permanently occlude large and small vessels. Case Presentation: A 52-year-old male [...] Read more.
Background and Clinical Significance: We wished to review the use of arterial embolization with n-butyl-cyanoacrylate (NBCA) to treat large high-flow vascular malformations due to its rapid polymerization and ability to permanently occlude large and small vessels. Case Presentation: A 52-year-old male presented with a two-year history of progressively worsening pain and swelling in the right gluteal area. Imaging techniques (color Doppler ultrasonography, CT, DSA, and MRI) were utilized for the diagnosis of a large high-flow intramuscular hemangioma. The mass displaced the surrounding tissues but showed no signs of lymphadenopathy or distant metastasis. The treatment involved targeting different arterial feeders over several sessions. Each procedure used NBCA–Lipiodol under fluoroscopic guidance, progressively reducing the malformation’s size and alleviating his symptoms. After the final embolization, the patient showed significant pain relief and a reduction in the size of the malformation, confirmed by follow-up imaging, demonstrating NBCA embolization’s effectiveness. The protocol’s safety and efficacy in this context are discussed. Conclusions: Arterial embolization with NBCA is a promising treatment for large high-flow vascular malformations, providing symptom relief and reductions in lesion size. While this case report highlights the procedure’s efficacy, further research is needed for a broader understanding of its long-term outcomes and potential complications. Full article
(This article belongs to the Section Oncology)
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6 pages, 7819 KiB  
Case Report
Successful Endovascular Management of Pseudoaneurysm following Transarterial Chemoembolization: A Case Report
by Joo Yeon Jang, Tae Un Kim, Hwaseong Ryu, Ki Tae Yoon, Young Mi Hong and Ung Bae Jeon
Medicina 2024, 60(5), 701; https://doi.org/10.3390/medicina60050701 - 25 Apr 2024
Viewed by 1435
Abstract
Background and Objectives: Transarterial chemoembolization (TACE) is a widely accepted treatment for hepatocellular carcinoma (HCC). Regarding TACE, arterial injuries, such as hepatic artery spasm or dissection, can also occur, although pseudoaneurysms are rare. We report a case of pseudoaneurysm following TACE. Materials [...] Read more.
Background and Objectives: Transarterial chemoembolization (TACE) is a widely accepted treatment for hepatocellular carcinoma (HCC). Regarding TACE, arterial injuries, such as hepatic artery spasm or dissection, can also occur, although pseudoaneurysms are rare. We report a case of pseudoaneurysm following TACE. Materials and Methods: A 78-year-old man had been undergoing TACE for HCC in segment 8 of the liver for the past 5 years, with the most recent TACE procedure performed approximately 1 month prior. He presented to the emergency department with melena that persisted for 5 days. Computed tomography revealed a pseudoaneurysm in the S8 hepatic artery with hemobilia. Results: the pseudoaneurysm was successfully treated by N-Butyl-cyanoacrylate glue embolization. Conclusions: In patients that have undergone TACE presenting with melena and hemobilia identified on CT, consideration of hepatic artery pseudoaneurysm is crucial. Such cases can be safely and effectively treated with endovascular managements. Full article
(This article belongs to the Collection Interventional Oncology)
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20 pages, 12103 KiB  
Article
Vertebro-Vertebral Arteriovenous Fistulae: A Case Series of Endovascular Management at a Single Center
by Pattarawit Withayasuk, Ritthikrai Wichianrat, Boonrerk Sangpetngam, Thaweesak Aurboonyawat, Ekawut Chankaew, Saowanee Homsud and Anchalee Churojana
Diagnostics 2024, 14(4), 414; https://doi.org/10.3390/diagnostics14040414 - 13 Feb 2024
Cited by 2 | Viewed by 2231
Abstract
Objective: Vertebro-vertebral arteriovenous fistulae (VVFs) are a rare disorder characterized by a direct shunt between the extracranial vertebral artery and the veins of the vertebral venous plexus. This study aims to comprehensively review the characteristics and outcomes of endovascular treatments for VVFs at [...] Read more.
Objective: Vertebro-vertebral arteriovenous fistulae (VVFs) are a rare disorder characterized by a direct shunt between the extracranial vertebral artery and the veins of the vertebral venous plexus. This study aims to comprehensively review the characteristics and outcomes of endovascular treatments for VVFs at our center. Methods: A retrospective review was conducted on 14 patients diagnosed with a VVF who underwent endovascular treatment at Siriraj Hospital from January 2000 to January 2023. The study assessed patient demographics, presentation, fistula location, treatment strategies, endovascular techniques employed, and treatment outcomes. Results: Among the 14 patients, 11 (78.6%) were female, with an age range from 25 to 79 years (median: 50 years). Spontaneous VVFs were observed in 64.3% of the cases, including three associated with neurofibromatosis type 1 (NF-1). Iatrogenic injury accounted for two cases, and three patients had VVFs resulting from traffic accidents. A pulsatile neck mass and tinnitus, with or without neurological deficits, were common presenting symptoms. Active bleeding was observed in three cases with vascular injury, while unilateral proptosis, congestive heart failure, and incidental findings each presented in one patient. All the VVFs were successfully obliterated without major treatment complications. Parent vessel sacrifice was performed in 85.7% of the cases, while vertebral artery preservation was achieved in the remaining two patients. Embolic materials included detachable balloons, detachable coils, and n-butyl cyanoacrylate (NBCA) glue. All the presenting symptoms showed improvement, and no morbidity or mortality was observed. Conclusions: Endovascular embolization is a feasible and effective approach for achieving complete VVF obliteration with safety. Parent artery sacrifice should not be reluctantly performed, particularly when adequate collateral circulation is demonstrated. Full article
(This article belongs to the Special Issue Advances in Cerebrovascular Imaging and Interventions)
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10 pages, 1708 KiB  
Case Report
EUS-Guided Combined Injection Therapy as a Secondary Prophylaxis of Gastric Variceal Bleeding in a Patient Contraindicated for TIPS: Case Report
by Krasimir Asenov, Rosen Dimov, Maria Kraeva and Yordanka Basheva-Kraeva
Medicina 2024, 60(1), 116; https://doi.org/10.3390/medicina60010116 - 8 Jan 2024
Cited by 2 | Viewed by 2296
Abstract
Background: Although bleeding from gastric varices is less observed than esophageal variceal bleeding (VB) (25% vs. 64%), it is associated with an exceedingly high mortality rate of up to 45%. Current guidelines suggest that endoscopic cyanoacrylate injection therapy (ECI) is the first-line [...] Read more.
Background: Although bleeding from gastric varices is less observed than esophageal variceal bleeding (VB) (25% vs. 64%), it is associated with an exceedingly high mortality rate of up to 45%. Current guidelines suggest that endoscopic cyanoacrylate injection therapy (ECI) is the first-line treatment for gastric variceal bleeding (GVB). A major concern, however, is the possibility of embolic incidents, which are clinically evident in approximately 1% of cases. There are no guidelines for secondary prophylaxis of GVB. Radiological treatments using a transjugular intrahepatic portosystemic shunt (TIPS) or balloon occlusive transvenous obliteration (BRTO) are considered viable. However, they are not universally inapplicable; for instance, in the setting of pulmonary hypertension (TIPS). EUS-guided combined injection therapy (EUS-CIT) (embolization coils + cyanoacrylate) is an emerging procedure with a perceived reduced risk of systemic embolization. Case presentation: A patient with alcoholic liver cirrhosis was subjected to EUS-CIT as a secondary prophylaxis for GVB. He had three VB episodes of prior presentation treated by endoscopic band ligation (EBL) and ECI. Due to recurrent episodes of bleeding, he was referred to TIPS, but was considered contraindicated due to severe pulmonary hypertension. EUS-CIT was conducted with two embolization coils inserted into the varix, followed by an injection of 1.5 mL of cyanoacrylate glue. A 19 Ga needle, 0.035″ 14/70 mm coils, non-diluted n-butyl-caynoacrylate, and a transgastric approach were utilized. There were no immediate complications. Complete obliteration of the GV was observed in a follow-up endoscopy on day 30. Subsequent endoscopies in months three and six showed no progression of gastric varices. Conclusions: Our initial experience with EUS-CIT suggests that it can be successfully used as secondary prophylaxis for recurrent GVB. Full article
(This article belongs to the Section Gastroenterology & Hepatology)
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13 pages, 5216 KiB  
Article
Iodixanol as a New Contrast Agent for Cyanoacrylate Embolization: A Preliminary In Vivo Swine Study
by Kévin Guillen, Pierre-Olivier Comby, Alexandra Oudot, Anne-Virginie Salsac, Nicolas Falvo, Thierry Virely, Olivia Poupardin, Mélanie Guillemin, Olivier Chevallier and Romaric Loffroy
Biomedicines 2023, 11(12), 3177; https://doi.org/10.3390/biomedicines11123177 - 29 Nov 2023
Viewed by 1827
Abstract
N-butyl cyanoacrylate (NBCA) is a lipophilic, permanent embolic glue that must be opacified for fluoroscopic guidance. Empirically, lipophilic Lipiodol Ultra Fluid® (LUF) has been added to produce a single-phase physically stable mixture. Varying the dilution ratio allows control of glue polymerization kinetics. [...] Read more.
N-butyl cyanoacrylate (NBCA) is a lipophilic, permanent embolic glue that must be opacified for fluoroscopic guidance. Empirically, lipophilic Lipiodol Ultra Fluid® (LUF) has been added to produce a single-phase physically stable mixture. Varying the dilution ratio allows control of glue polymerization kinetics. LUF is far more costly than water-soluble iodinated contrast agents (ICAs). Our purpose was to evaluate whether a water-soluble nonionic iso-osmolar ICA could be used instead. We embolized both renal arteries of six swine using 1:3 NBCA–LUF or NBCA–iodixanol in 1:1, 1:3, and 1:7 ratios. We used both micro-computed tomography to assess the distality of glue penetration and indexed cast ratio and histology to assess distality, arterial obliteration, vessel-wall damage, and renal-parenchyma necrosis. Glue–LUF produced significantly greater indexed cast ratio and renal-artery ROI values and a significantly shorter cast-to-capsule distance. The injected volume was significantly greater with 1:7 iodixanol than with the other mixtures. No significant differences were found for histological evidence of artery obliteration, vessel-wall damage, or renal-parenchyma necrosis. This is the first study dealing with ICA alone as a contrast agent for cyanoacrylate embolization, compared to LUF. More research is needed to determine whether water-soluble nonionic iodinated agents can be used for human NBCA embolization given the good safety profile, availability, and low cost of ICA. Full article
(This article belongs to the Section Molecular and Translational Medicine)
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15 pages, 7477 KiB  
Article
Selective Arterial Embolization of Ruptured Hepatocellular Carcinoma with N-Butyl Cyanoacrylate and Lipiodol: Safety, Efficacy, and Short-Term Outcomes
by Jory Cali, Olivier Chevallier, Kévin Guillen, Marianne Latournerie, Amin Mazit, Ludwig Serge Aho-Glélé and Romaric Loffroy
J. Pers. Med. 2023, 13(11), 1581; https://doi.org/10.3390/jpm13111581 - 7 Nov 2023
Cited by 1 | Viewed by 1736
Abstract
The rupture of hepatocellular carcinoma (rHCC) is uncommon but causes sudden life-threatening bleeding. Selective transarterial embolization (STAE) is an effective bleeding-control option. The optimal embolic agent is unknown, and data on the use of cyanoacrylate glue are lacking. The objective of this study [...] Read more.
The rupture of hepatocellular carcinoma (rHCC) is uncommon but causes sudden life-threatening bleeding. Selective transarterial embolization (STAE) is an effective bleeding-control option. The optimal embolic agent is unknown, and data on the use of cyanoacrylate glue are lacking. The objective of this study was to report the outcomes of cyanoacrylate-lipiodol embolization for rHCC. We retrospectively reviewed the files of the 16 patients (14 males; mean age, 72 years) who underwent emergency cyanoacrylate-lipiodol STAE at a single center in 2012–2023 for spontaneous rHCC. All 16 patients had subcapsular HCC and abundant hemoperitoneum. The technical success rate was 94% (15/16). Day 30 mortality was 19%; the three patients who died had severe hemodynamic instability at admission; one death was due to rebleeding. Liver enzyme levels returned to baseline by day 30. No rebleeding was recorded during the median follow-up of 454 days in the 10 patients who were alive with available data after day 30. Larger prospective studies with the collection of longer-term outcomes are needed to assess our results supporting the safety and effectiveness of cyanoacrylate-lipiodol STAE for rHCC. Randomized trials comparing this mixture to other embolic agents should be performed. Full article
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21 pages, 1760 KiB  
Review
Neuroendovascular Surgery Applications in Craniocervical Trauma
by Michael Kim, Galadu Subah, Jared Cooper, Michael Fortunato, Bridget Nolan, Christian Bowers, Kartik Prabhakaran, Rolla Nuoman, Krishna Amuluru, Sauson Soldozy, Alvin S. Das, Robert W. Regenhardt, Saef Izzy, Chirag Gandhi and Fawaz Al-Mufti
Biomedicines 2023, 11(9), 2409; https://doi.org/10.3390/biomedicines11092409 - 28 Aug 2023
Cited by 4 | Viewed by 2691
Abstract
Cerebrovascular injuries resulting from blunt or penetrating trauma to the head and neck often lead to local hemorrhage and stroke. These injuries present with a wide range of manifestations, including carotid or vertebral artery dissection, pseudoaneurysm, occlusion, transection, arteriovenous fistula, carotid-cavernous fistula, epistaxis, [...] Read more.
Cerebrovascular injuries resulting from blunt or penetrating trauma to the head and neck often lead to local hemorrhage and stroke. These injuries present with a wide range of manifestations, including carotid or vertebral artery dissection, pseudoaneurysm, occlusion, transection, arteriovenous fistula, carotid-cavernous fistula, epistaxis, venous sinus thrombosis, and subdural hematoma. A selective review of the literature from 1989 to 2023 was conducted to explore various neuroendovascular surgical techniques for craniocervical trauma. A PubMed search was performed using these terms: endovascular, trauma, dissection, blunt cerebrovascular injury, pseudoaneurysm, occlusion, transection, vasospasm, carotid-cavernous fistula, arteriovenous fistula, epistaxis, cerebral venous sinus thrombosis, subdural hematoma, and middle meningeal artery embolization. An increasing array of neuroendovascular procedures are currently available to treat these traumatic injuries. Coils, liquid embolics (onyx or n-butyl cyanoacrylate), and polyvinyl alcohol particles can be used to embolize lesions, while stents, mechanical thrombectomy employing stent-retrievers or aspiration catheters, and balloon occlusion tests and super selective angiography offer additional treatment options based on the specific case. Neuroendovascular techniques prove valuable when surgical options are limited, although comparative data with surgical techniques in trauma cases is limited. Further research is needed to assess the efficacy and outcomes associated with these interventions. Full article
(This article belongs to the Special Issue Advanced Research on Cerebrovascular Diseases)
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14 pages, 18665 KiB  
Article
Endovascular Aneurysm Sac Embolization for Treatment of Ruptured Aneurysms in the Aortoiliac Segment Using N-Butyl-Cyanoacrylate
by Karim Mostafa, Marie Schierenbeck, Jens Trentmann, Hannes Gottschalk, Julian Andersson, Julian Pfarr, Malte Sieren, Olav Jansen and Philipp J. Schäfer
Life 2023, 13(4), 919; https://doi.org/10.3390/life13040919 - 31 Mar 2023
Viewed by 2054
Abstract
Background Aneurysmal rupture in the aortoiliac segment is a severe, life-threatening condition. Nowadays, in addition to surgical treatment, the implantation of a covered stent graft constitutes a feasible, minimally invasive treatment option. A novel approach is the add-on of transarterial aneurysm sac embolization [...] Read more.
Background Aneurysmal rupture in the aortoiliac segment is a severe, life-threatening condition. Nowadays, in addition to surgical treatment, the implantation of a covered stent graft constitutes a feasible, minimally invasive treatment option. A novel approach is the add-on of transarterial aneurysm sac embolization with N-butyl-cyanoacrylate (NBCA). Here, we report our experience of performing this add-on embolization procedure after endovascular aneurysm repair for complex ruptured aneurysms of the aortoiliac segment. Material and Methods We describe six patients (mean age of 75.2 years; all male) with ruptured aneurysms in the visceral aortic and aortoiliac segment in whom a high-volume transarterial aneurysm sac embolization was performed as an add-on therapy to the implantation of an aortic prosthesis. The aim of this add-on intervention was to achieve the definite embolization of the aneurysmal rupture site and to ensure the best possible aneurysmal sealing. We report the feasibility, technical success, and considerations of using NBCA as well as clinical and follow-up imaging results, given their availability. Results Technical success was achieved in all cases. Clinical success was achieved in four cases. No periprocedural complications or reinterventions were reported. The mean full procedure time was 107.8 min. The mean radiation dose was 12,966.1 cGy/cm2. A mean amount of 10.7 mL of NBCA mixed with lipiodol in a 1:3 to 1:5 ratio was used for all patients. Available follow-up imaging up to 36 months after the procedure showed no aneurysm progression or endoleaks. In two patients, the NBCA cast had almost fully dissolved over the course of follow-up. Conclusions Our study underscores the notion that aneurysm sac embolization using high volumes of NBCA with ethiodized oil as an embolic agent is a feasible and add-on treatment option for optimizing the exclusion of the aneurysm from patients with ruptured aneurysms in the aortoiliac segment. Full article
(This article belongs to the Special Issue Mechanism, Diagnosis, and Treatment of Aortic Diseases)
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13 pages, 1344 KiB  
Article
X-ray Microtomography to Assess Determinants of In Vivo N-Butyl Cyanoacrylate Glubran®2 Polymerization: A Rabbit-Model Study
by Kévin Guillen, Pierre-Olivier Comby, Anne-Virginie Salsac, Nicolas Falvo, Marc Lenfant, Alexandra Oudot, Hugo Sikner, Anne Dencausse, Emilie Laveissiere, Serge Ludwig Aho-Glele and Romaric Loffroy
Biomedicines 2022, 10(10), 2625; https://doi.org/10.3390/biomedicines10102625 - 19 Oct 2022
Cited by 3 | Viewed by 2047
Abstract
Although introduced decades ago, few cyanoacrylate glues have been approved for endovascular use, despite evidence of their usefulness, notably for complex procedures suchas hemostatic embolization. Indications include massive bleeding requiring emergent hemostasis and prevention of severe bleeding during scheduled surgery to remove a [...] Read more.
Although introduced decades ago, few cyanoacrylate glues have been approved for endovascular use, despite evidence of their usefulness, notably for complex procedures suchas hemostatic embolization. Indications include massive bleeding requiring emergent hemostasis and prevention of severe bleeding during scheduled surgery to remove a hypervascular tumor. Adding radiopaque Lipiodol Ultra Fluid® (LUF) modulates glue polymerization and allows fluoroscopic guidance, but few comparative in vivo studies have assessed the impact of the resulting change in glue concentration or of other factors such as target-vessel blood flow. In a rabbit model, we used ex vivo X-ray microtomography to assess the results of in vivo renal-artery embolization by various mixtures of N-butyl cyanoacrylate (NBCA), metacryloxysulfolane, and LUF. Overall, penetration to the superficial interlobular arteries was achieved in about two-thirds of cases and into the capillaries in nearly half the cases, while cast fragmentation was seen in slightly more than half the cases. Greater NBCA dilution and the blocked-blood-flow technique were independently associated with greater distality of penetration. Blocked-blood-flow injection was independently associated with absence of fragmentation, capillary penetration, a shorter cast-to-capsule distance, and higher cast attenuation. A larger mixture volume was independently associated with higher indexed cast ratio and deeper penetration. Finally, microtomography is an adapted tool to assess ex vivo distribution of glue cast. Full article
(This article belongs to the Section Molecular and Translational Medicine)
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5 pages, 3650 KiB  
Case Report
Percutaneous N-Butyl-Cyanoacrylate Embolization for Treating Ruptured Pancreaticoduodenal Aneurysm: A Case Report
by Joo Yeon Jang, Jin Hyeok Kim, Tae Un Kim, Hwaseong Ryu, Tae Beom Lee, Je Ho Ryu and Ung Bae Jeon
Medicina 2022, 58(10), 1320; https://doi.org/10.3390/medicina58101320 - 21 Sep 2022
Cited by 1 | Viewed by 1670
Abstract
Background and Objectives: Pancreaticoduodenal artery aneurysms are rare visceral artery aneurysms. Interventional treatments, including transcatheter embolization, have an acceptable success rate. We report a case of ruptured pancreaticoduodenal aneurysm that was successfully treated with percutaneous N-Butyl-cyanoacrylate (NBCA) embolization after failed transcatheter embolization. [...] Read more.
Background and Objectives: Pancreaticoduodenal artery aneurysms are rare visceral artery aneurysms. Interventional treatments, including transcatheter embolization, have an acceptable success rate. We report a case of ruptured pancreaticoduodenal aneurysm that was successfully treated with percutaneous N-Butyl-cyanoacrylate (NBCA) embolization after failed transcatheter embolization. Materials and Methods: A 53-year-old man presented to the emergency department with abdominal pain. Computed tomography (CT) revealed a ruptured aneurysm in the inferior pancreaticoduodenal artery (IPDA) with retrohemoperitoneum. The patient underwent percutaneous NBCA embolization after transcatheter embolization failure. Results: On CT, the pancreaticoduodenal aneurysm was completely embolized. No additional bleeding events occurred. Conclusions: Percutaneous NBCA embolization is safe and effective for treating patients with ruptured pancreaticoduodenal aneurysms after failed transcatheter embolization. Full article
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12 pages, 1641 KiB  
Article
Transcatheter Arterial Embolization (TAE) Using N-Butyl-2-cyanoacrylate (NBCA) as the First Choice for Postpartum Vulvovaginal Hematoma; Case Series and Reviews of the Literature
by Takuya Misugi, Akihiro Hamuro, Kohei Kitada, Yasushi Kurihara, Mie Tahara, Eisaku Terayama, Ken Kageyama, Akira Yamamoto and Daisuke Tachibana
Diagnostics 2022, 12(6), 1429; https://doi.org/10.3390/diagnostics12061429 - 9 Jun 2022
Cited by 1 | Viewed by 2190
Abstract
Transcatheter arterial embolization (TAE) has long been reported to be safe, effective, and to have a high clinical and technical success rate for vulvovaginal hematoma. We used a permanent embolic material, diluted N-butyl-2-cyanoacrylate (NBCA), for the first choice intervention for six cases of [...] Read more.
Transcatheter arterial embolization (TAE) has long been reported to be safe, effective, and to have a high clinical and technical success rate for vulvovaginal hematoma. We used a permanent embolic material, diluted N-butyl-2-cyanoacrylate (NBCA), for the first choice intervention for six cases of vulvovaginal hematoma, in order to confirm the effectiveness of NBCA. Regarding post-embolization adverse events, we did not observe any fever nor necrosis or pain in the vaginal wall or vulva, in all cases. The use of NBCA as a first-line treatment for TAE of vulvovaginal hematoma is considered to be effective, in the following two ways: First, hemostasis can be achieved by adjusting the mixing ratio of NBCA and lipiodol, according to the distance between the tip of the catheter and the site of injury. Second, NBCA does not cause complications such as pain, necrosis, or infection, and it can be used safely. There are no reports clearly recommending NBCA as the first choice in the treatment of TAE for vulvovaginal hematoma. This is the first report to examine the efficacy and safety of NBCA as the first-line intervention for such cases. Full article
(This article belongs to the Section Medical Imaging and Theranostics)
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8 pages, 1867 KiB  
Article
Imaging-Guided Percutaneous Puncture and Embolization of Visceral Pseudoaneurysms: Feasibility and Outcomes
by Serena Carriero, Carolina Lanza, Pierpaolo Biondetti, Matteo Renzulli, Cristian Bonelli, Filippo Piacentino, Federico Fontana, Massimo Venturini, Gianpaolo Carrafiello and Anna Maria Ierardi
J. Clin. Med. 2022, 11(11), 2952; https://doi.org/10.3390/jcm11112952 - 24 May 2022
Cited by 9 | Viewed by 2289
Abstract
Visceral artery pseudoaneurysms (VAPAs) are the most frequently diagnosed pseudoaneurysms (PSAs). PSAs can be asymptomatic or symptomatic. The aim of our study was to evaluate the safety and effectiveness of percutaneous embolization of VAPAs performed on patients with an unfeasible trans-arterial approach. Fifteen [...] Read more.
Visceral artery pseudoaneurysms (VAPAs) are the most frequently diagnosed pseudoaneurysms (PSAs). PSAs can be asymptomatic or symptomatic. The aim of our study was to evaluate the safety and effectiveness of percutaneous embolization of VAPAs performed on patients with an unfeasible trans-arterial approach. Fifteen patients with fifteen visceral PSAs, with a median dimension of 21 mm (IQR 20–24 mm), were retrospectively analyzed. No patients were suitable for trans-arterial catheterization and therefore a percutaneous approach was chosen. During percutaneous treatments, two embolic agents were used, either N-butyl cyanoacrylate (NBCA) (Glubran II, GEM Milan, Italy) mixed with Lipiodol (Lipiodol, Guerbet, France) or thrombin. The outcomes of this study were technical success, primary clinical success, and secondary clinical success. In our population the 15 PSA were located as follows: 2 in the left gastric artery, 1 in the right gastric artery, 3 in the right hepatic artery, 2 in a jejunal artery, 1 in left colic artery branch, 1 in a right colic artery branch, 1 in the gastroepiploic artery, 1 in the dorsal pancreatic artery, 1 in an ileocolic artery branch, 1 in an iliac artery branch, and 1 in a sigmoid artery branch. 80% of PSAs (12/15) were treated with a NBCA:lipiodol mixture and 20% of PSAs (3/15) were treated with thrombin. Technical, primary, and secondary clinical successes were obtained in 100% of the cases. No harmful or life-threatening complications were observed. Minor complications were registered in 26.6% (4/15) of the patients. Percutaneous embolization of visceral PSA is a safe and effective treatment and should be considered as an option when the endovascular approach is unsuccessful or unfeasible. Full article
(This article belongs to the Section Vascular Medicine)
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15 pages, 296 KiB  
Review
Endovascular Management of Hemorrhagic Stroke
by Basel Musmar, Nimer Adeeb, Junaid Ansari, Pankaj Sharma and Hugo H. Cuellar
Biomedicines 2022, 10(1), 100; https://doi.org/10.3390/biomedicines10010100 - 4 Jan 2022
Cited by 14 | Viewed by 4219
Abstract
Significant advances in endovascular neurosurgery tools, devices, and techniques are changing the approach to the management of acute hemorrhagic stroke. The endovascular treatment of intracranial aneurysms emerged in the early 1990s with Guglielmi detachable coils, and since then, it gained rapid popularity that [...] Read more.
Significant advances in endovascular neurosurgery tools, devices, and techniques are changing the approach to the management of acute hemorrhagic stroke. The endovascular treatment of intracranial aneurysms emerged in the early 1990s with Guglielmi detachable coils, and since then, it gained rapid popularity that surpassed open surgery. Stent-assisted coiling and balloon remodeling techniques have made the treatment of wide-necked aneurysms more durable. With the introduction of flow diverters and flow disrupters, many aneurysms with complex geometrics can now be reliably managed. Arteriovenous malformations and fistulae can also benefit from endovascular therapy by embolization using n-butyl cyanoacrylate (NBCA), Onyx, polyvinyl alcohol (PVA), and coils. In this article, we describe the role of endovascular treatment for the most common causes of intracerebral and subarachnoid hemorrhages, particularly ruptured aneurysms and vascular malformations. Full article
(This article belongs to the Special Issue Stroke—Pathophysiology and New Therapeutic Strategies)
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