Initial experience with precipitating hydrophobic injectable liquid in cerebral arteriovenous malformations

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p> Precipitating hydrophobic injectable liquid is a newly introduced liquid embolic agent for endovascular embolization with some technical advantages over other liquid embolic agents. We present our initial experience with precipitating hydrophobic injectable liquid in the endovascular treatment of cerebral arteriovenous malformations. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> From October 2015 to January 2018, 27 patients harboring cerebral arteriovenous malformations underwent endovascular embolization with precipitating hydrophobic injectable liquid 25. Clinical features, angiographic results, procedural details, complications, and follow-up details were retrospectively analyzed. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Twenty-seven patients with cerebral arteriovenous malformations were included. Total obliteration in one endovascular session was confirmed for 14/27 (52%) patients. Partial embolization was attained in 13 patients (48%) in whom staged treatment with following radiosurgery or surgery was planned. No mortality was recorded in this series. Complications during or after the embolization occurred in six of 27 (22.2%) patients. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> In our initial experience, precipitating hydrophobic injectable liquid has acceptable clinical outcome comparable to other liquid embolic agents. Although this is the largest reported study in arteriovenous malformation treatment with precipitating hydrophobic injectable liquid, further studies are needed to validate its safety and efficacy. </jats:p></jats:sec>

Glue, Onyx, Squid or PHIL? Liquid Embolic Agents for the Embolization of Cerebral Arteriovenous Malformations and Dural Arteriovenous Fistulas

“…To date, AVM embolization using PHIL was the focus of four clinical studies, of which all included only a limited number of patients [71][72][73][74]. These studies, which altogether included not more than 50 patients, demonstrated that PHIL is effective and safe for cerebral AVM embolization.…”

Liquid Embolics: A Guide to Currently Available and Pipeline Products

“…PHIL, which is available on the market in Europe, has been described in both neuro and peripheral interventions. 40 41 PHIL also does not pose a risk for gluing a microcatheter into the artery and one study demonstrated that PHIL has a greater volume of precipitation per milliliter volume injected than Onyx, 42 suggesting less PHIL would be required to fill a vessel than Onyx. However, one histologic comparison of Onyx and PHIL found greater inflammation around PHIL comparatively, 43 although this same analysis failed to show angiogenesis and found deeper penetration of the embolic in PHIL.…”

Advancements in the development on new liquid embolic agents for use in therapeutic embolisation

“…The precipitating hydrophobic injectable liquid PHIL s (Micro-Vention (Terumo Corp)) is indicated for the embolisation of the peripheral and neurovasculature, including AVMs and hypervascular tumours. [47][48][49] The liquid embolic is delivered using DMSO as the carrier solvent which on mixing with blood diffuses away as the polymeric material precipitates out of solution on contact with the aqueous environment within the vasculature to form a solid embolus. The polymer is based on a 2,4,6-triidophenol-lactide-lactide-co-glycolic acrylate and hydroxyethyl-methacrylate (HEMA) (2 : 1 monomer ratio) copolymer which is non-adhesive in nature so avoids adhesion to the microcatheter during delivery (Fig.…”