Initial experience with the new ethylene vinyl alcohol copolymer based liquid embolic agent Menox in the endovascular treatment of cerebral arteriovenous malformations

Sirakov, Stanimir; Sirakov, Alexander; Minkin, Krasimir; Penkov, Marin; Ninov, Kristian; Hristov, Hristo; Karakostov, Vasil; Raychev, Radoslav

doi:10.1136/neurintsurg-2019-014963

Cited by 6 publications

(7 citation statements)

References 22 publications

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“…The development of new LEAs and materials has had a major impact on the treatment of cerebral AVMs and shunts (1,9,(13)(14)(15) . Onyx is currently the most commonly used non-adhesive LEA for intracranial endovascular embolization (5)(6)(7) .…”

Section: Discussionmentioning

confidence: 99%

“…Recent technological advances, such as the development of liquid embolic agents (LEAs), have increased embolization success rates. The most widely used LEAs are non-adhesive copolymers of ethylene-vinyl alcohol (EVOH), including Onyx (Covidien, Irvine, CA, USA) and the newly developed Menox (Meril Life Sciences, Gujarat, India), both of which have been evaluated in various studies (5)(6)(7)(8)(9) . The purpose of this study was to evaluate the feasibility, reproducibility, and safety of the Menox liquid embolic system (LES), in comparison with the Onyx LES, in a porcine model of AVM embolization.…”

Section: Introductionmentioning

confidence: 99%

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Acute and chronic changes in porcine rete mirabile after embolization with the Menox system: angiographic and histopathological analyses

et al. 2023

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Objective: To evaluate acute and chronic changes seen on angiographic and histopathological studies of porcine rete mirabile, comparing those treated with the Menox liquid embolic system (LES) and those treated with the Onyx LES. Materials and Methods: Five pigs, each weighing approximately 35 kg, were submitted to rete mirabile embolization under general anesthesia and fluoroscopic guidance, with the Menox LES or Onyx LES. Four animals were treated with the Menox LES and underwent cerebral angiography, followed by euthanasia, at 1, 30, 60, and 90 days after embolization. One animal was treated with the Onyx LES underwent the same procedures at 30 days after embolization. In a subsequent histopathological analysis, we compared the Menox LES and Onyx LES in terms of the acute and chronic changes observed. Results: We observed no significant changes in blood pressure, heart rate, or electrocardiographic parameters that could be attributed to the super-selective infusion of dimethyl sulfoxide or the Menox embolic agent. Fluoroscopy showed adequate material opacity, appropriate progression to the center of the rete mirabile and complete unilateral embolization. Microcatheters were uneventfully detached from the embolized nidus. We observed mild to moderate intravascular and extravascular inflammatory responses, without histological evidence of necrotizing arteritis. There were no adverse neurovascular events. Conclusion: The Menox LES appears to be safe and effective, as well as being apparently equivalent to the Onyx LES in terms of the postprocedure angiographic and histopathological findings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute and chronic changes in porcine rete mirabile after embolization with the Menox system: angiographic and histopathological analyses

et al. 2023

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“…GPX has several major advantages compared with commonly used liquid embolic agents like Onyx, glue, PHIL, Squid, or the novel liquid embolic agent Menox, which offers similar technical and clinical results in the endovascular treatment of arteriovenous malformations in comparison with the other currently available liquid embolic agents. 36 First, GPX does not rely on precipitation with dimethyl sulfoxide (Onyx, PHIL, Squid, Menox) or in situ polymerization (glue). Due to its water-based composition, no specialized catheters or catheter pre-flush are needed, in contrast to Onyx, PHIL, Squid, and Menox which require dimethyl sulfoxide, and glue which requires D5W.…”

Section: Discussionmentioning

confidence: 99%

Treatment of experimental aneurysms with a GPX embolic agent prototype: preliminary angiographic and histological results

Fries

Tomori

Schulz‐Schaeffer

et al. 2021

J NeuroIntervent Surg

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BackgroundRecently, liquid embolic agents have emerged for the endovascular treatment of cerebral aneurysms. Here we describe the in vivo performance of a novel liquid embolization agent (GPX Embolic Device).MethodsElastase-induced aneurysms were embolized with a GPX prototype under balloon assistance. Digital subtraction angiography was performed pre-deployment and immediately after, and at 5, 10, and 30 min post-deployment in 10 rabbits and at 1 month in 8 rabbits. The early post-deployment intra-aneurysmal flow was graded as unchanged, moderately diminished, or completely absent. At 1 month the status of aneurysm occlusion was evaluated. Adhesion to catheter material and migration of GPX was assessed.ResultsThe mean aneurysm neck diameter, width, and height were 3.6±1.0 mm, 3.0±0.8 mm, and 7.4±1.4 mm, respectively. The mean dome-to-neck ratio was 0.9±0.2. Complete stagnation of intra-aneurysmal flow was observed in 9 of 10 aneurysms (90%) within 30 min of device deployment. One aneurysm showed moderately diminished intra-aneurysmal flow at 30 min. At 1 month, 8 aneurysms were completely occluded. There was no evidence of GPX adhesion to the catheter material. Histologically, a leukocyte and foreign body reaction to GPX was detectable 28 days after embolization.ConclusionsThis is the first preclinical study reporting the performance of a protype version of the GPX Embolic Device in a wide-neck aneurysm model. GPX showed promising results by achieving and maintaining high rates of complete angiographic occlusion, but may induce an inflammatory reaction.

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“…The reported injection pause times and the mean fluoroscopy times were relatively shorter than those we observe on a daily basis in comparison with injections of EVOH or PHIL as stand-alone liquid embolic agents. 16,17 However, direct head-to-head comparison is difficult to perform with great accuracy because each AVM has distinct anatomic and flow characteristics.…”

Section: Discussionmentioning

confidence: 99%

Intermixed Dimethyl-Sulfoxide–Based Nonadhesive Liquid Embolic Agents Delivered Serially via the Same Microcatheter for Cerebral AVM Treatment

Sirakov¹,

Minkin

Sirakov³

2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Conventional nonadhesive liquid embolic agents currently are the criterion standard for endovascular embolization of cerebral AVMs. However, inadequate distal penetration into the nidus and unstable proximal plug formation are the major limitations of this approach and of the currently available embolic materials. The aim of this study was to evaluate the hypothetic efficacy of combining liquid embolic agents with different properties and viscosities for use in endovascular embolization of cerebral AVMs. MATERIALS AND METHODS:From March 2018 to March 2019, sixteen patients with cerebral AVMs (12 women, 4 men; age range, 33-61 years) underwent endovascular embolization with combined liquid embolic agents delivered serially via a single microcatheter. The procedure consists of initial embolization with PHIL 30%, followed by Menox 18 through the same microcatheter. According to the Spetzler-Martin scale, 11 (68.75%) AVMs were grades I-II, 4 (25%) were grade III, and 1 (6.25%) was grade IV. Angiographic, technical, and clinical outcomes were analyzed independently. RESULTS:Combined PHIL and Menox embolization through the same microcatheter via 21 pedicles was performed in these 16 patients. Once the length of the reflux reached approximately 2 cm, PHIL 30% was switched to Menox 18. Antegrade flow and distal penetration of the serially applied liquid embolic agents were observed in all 16 cases. The ability to completely control the flow of the materials and avoid any dangerous proximal reflux was noted in all performed embolizations. The estimated average size reduction of the treated AVMs was 85%, ranging from 50% to 100%. Complete embolization was achieved in 10/16 or 62.5% of the cases. There was no procedure-related complication during or after the embolization. No mortality or postprocedural clinical worsening was seen. Clinical success and complete obliteration were confirmed with at least 1 follow-up angiography in 10/16 patients.CONCLUSIONS: Serial delivery of nonadhesive liquid embolic agents via the same microcatheter was safe and effective in our study and may be a potential technique for routine AVM treatment. However, further investigations are required to validate the safety and the efficacy of the method.

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Initial experience with the new ethylene vinyl alcohol copolymer based liquid embolic agent Menox in the endovascular treatment of cerebral arteriovenous malformations

Cited by 6 publications

References 22 publications

Acute and chronic changes in porcine rete mirabile after embolization with the Menox system: angiographic and histopathological analyses

Acute and chronic changes in porcine rete mirabile after embolization with the Menox system: angiographic and histopathological analyses

Treatment of experimental aneurysms with a GPX embolic agent prototype: preliminary angiographic and histological results

Intermixed Dimethyl-Sulfoxide–Based Nonadhesive Liquid Embolic Agents Delivered Serially via the Same Microcatheter for Cerebral AVM Treatment

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