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Research ArticleNeurointervention

High-Concentration Ethylene-Vinyl Alcohol Copolymer and Endovascular Treatment of Experimental Aneurysms: Feasibility of Embolization without Protection Devices at the Neck

Jean Raymond, Igor Salazkin, Annick Metcalfe, François Guilbert, Alain Weill and Daniel Roy
American Journal of Neuroradiology October 2003, 24 (9) 1778-1784;
Jean Raymond
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Igor Salazkin
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Annick Metcalfe
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François Guilbert
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Alain Weill
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Daniel Roy
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    Fig 1.

    HCEVOH embolization of aneurysms

    Selected frames from angiographic monitoring of endovascular intervention show initial kernel formation (arrow, A), progressive enlargement of HCEVOH mass (B), final (C), and follow-up angiographic results at 3 months (D). Arrowheads in panel A indicate metallic markers on microcatheter. S indicates surgical clips at fundus of aneurysm. Note minimal neck remnant (arrow, D).

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    Fig 2.

    Complication and recurrence with HCEVOH embolization

    Selected frames from angiographic monitoring of procedure showing (A) stringing of HCEVOH and carotid embolization (arrows), excess HCEVOH protrusion (B, C), tearing of attached material (arrow, C) on catheter retrieval (D), and recurrence 3 months (arrows, F) after satisfactory occlusion of bifurcation aneurysm (E). The apparent residuum in panel E consists mostly of the bifurcation itself surgically constructed to obtain this morphology associated with a high incidence of recurrence (9).

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    Fig 3.

    Macroscopic observations after HCEVOH embolization

    Photography of specimens 3 months after embolization showing recurrence (A–C) or excess protrusion (D–F). Note complete neointima formation over HCEVOH (F) and recanalizing crescents in an example of recurrence (arrows, C).

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    Fig 4.

    Neointima formation over HCEVOH

    Macroscopic photography (A, C) and corresponding histopathologic sections (B, D) of neointima formation over HCEVOH at the neck of the aneurysm (A, B) or over an example of protrusion in the carotid artery (C, D). (B, D: Movat’s pentachrome stain; original magnification ×200).

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    Fig 5.

    Pathologic findings 3 months after HCEVOH embolization

    Note complete replacement of aneurysmal sac with HCEVOH (A) and excellent neointima formation at the neck (B). Some tissue septations can be found within HCEVOH mass (C). A recanalizing crescent related to recurrence is shown in panel D (arrow). (A, D: Movat’s pentachrome stain; B, C: Hematoxylin Phloxin Saffron (HPS) stain; Original magnification: A, ×100; B and D, ×400, C, ×200).

Tables

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  • Treatment groups and results

    nProtrusionMedian Angiographic ScoresMedian Neointimal Scores
    T0T3 weeksT12 weeks
    Platinum coils1040333
    HCEVOH127023a2b
    • a: P = .807;

    • b: P = .3

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American Journal of Neuroradiology: 24 (9)
American Journal of Neuroradiology
Vol. 24, Issue 9
1 Oct 2003
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Cite this article
Jean Raymond, Igor Salazkin, Annick Metcalfe, François Guilbert, Alain Weill, Daniel Roy
High-Concentration Ethylene-Vinyl Alcohol Copolymer and Endovascular Treatment of Experimental Aneurysms: Feasibility of Embolization without Protection Devices at the Neck
American Journal of Neuroradiology Oct 2003, 24 (9) 1778-1784;

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High-Concentration Ethylene-Vinyl Alcohol Copolymer and Endovascular Treatment of Experimental Aneurysms: Feasibility of Embolization without Protection Devices at the Neck
Jean Raymond, Igor Salazkin, Annick Metcalfe, François Guilbert, Alain Weill, Daniel Roy
American Journal of Neuroradiology Oct 2003, 24 (9) 1778-1784;
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  • Safety and Effectiveness of Radioactive Coil Embolization of Aneurysms: Effects of Radiation on Recanalization, Clot Organization, Neointima Formation, and Surrounding Nerves in Experimental Models
  • Role of the Endothelial Lining in Recurrences After Coil Embolization: Prevention of Recanalization by Endothelial Denudation
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