Embolization of cerebral aneurysms with a liquid embolus, EVAL mixture: Report of three cases

Abstract

Embolization of three surgically difficult cerebral aneurysms was performed using our newly developed non-adhesive embolic material, EVAL mixture (ethylene vinyl alcohol copolymer). Conventional embolic materials such as detachable balloons or microcoils were not used because of a large or irregular aneurysmal neck. After temporary occlusion of the parent artery with a superselective balloon catheter, the EVAL mixture was slowly injected through a microcatheter placed in the aneurysm or parent artery. The locations of the aneurysms were anterior communicating artery, basilar artery-posterior cerebral artery and basilar artery-anterior inferior cerebellar artery (BA-AICA). One aneurysmal occlusion and 2 parent artery occlusions were performed. Patients had no persistent deficits. The patient with the BA-AICA aneurysm associated with an arteriovenous malformation died of rupture of the residual AVM due to haemodynamic change 2 weeks after embolization. In selected and limited cases, embolization of surgically difficult cerebral aneurysms using EVAL mixture was more effective and safer than embolization using conventional embolic materials such as balloons and microcoils.

Endoscopic augmentation of the cardia with a biocompatible injectable polymer (Enteryx) in a porcine model

“…Complete solidi®cation occurs in less than 1 min, with no distal migration or fragmentation of the implant. The liquid material comprised of EVOH has been used clinically in the embolization of arteriovenous malformations, aneurysms, and peripherovascular abnormalities and in head and neck tumors [12,18].…”

Subarachnoid Hemorrhage Caused by Rupture of a Distal Anterior Inferior Cerebellar Artery Aneurysm -Three Case Reports-

“…2,3,10,11) Treatment of only the aneurysm or only the AVM in this region might lead to increased risk of bleeding from the remaining lesion because of the altered hemodynamics. 10,12,13,16) In our second case, the ruptured lesion was neither an AVM nor an aneurysm associated with AVM. The second angiography revealed enlargement of the aneurysm, possibly indicating that the ruptured lesion was located in the same vascular network as the resected vascular anomaly.…”

Accuracy and interobserver reliability of three-dimensional rotational angiography versus mathematical models for volumetric measurement of intracranial aneurysms

“…1 Liquid embolic polymers are also emerging as a potential alternative to coiling, to achieve better filling of the aneurysm sac. [13][14][15][16][17][18][19][20] These methods may also substantially benefit from the volumetric assessment of the aneurysm cavity. 21 The accuracy of 3D-RA has been assessed using both iron balls 1 and phantom models.…”