Comparing N-hexyl cyanoacrylate (Magic Glue) and N-butyl cyanoacrylate (NBCA) for neurovascular embolization using the pressure cooker technique: An experimental study in swine - 24/01/21

Doi : 10.1016/j.neurad.2020.12.005

Lorena Nico ^a, Elsa Magro ^b,^c, Julien Ognard ^a,^c, Robert Fahed ^d, Igor Salazkin ^e, Guylaine Gevry ^e, Tim Darsaut ^f, Jean Raymond ^e,^g, Jean-Christophe Gentric ^a,^h,⁎
^a Division of Interventional Neuroradiology, Department of Radiology, University Hospital of Brest, France
^b Department of Neurosurgery, University Hospital of Brest. Bd. Tanguy Prigent, 29609 Brest Cedex, France
^c Laboratory of Medical Information Processing — LaTIM INSERM UMR 1101, Brest, France
^d Department of Medicine, Division of Neurology, Ottawa Hospital, Ottawa, Canada
^e Interventional Neuroradiology Laboratory, Research Centre, University of Montreal Hospital (CHUM), Notre-Dame Hospital, Montreal, Quebec, Canada
^f Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Science Centre, Edmonton, Alberta, Canada
^g Department of Radiology, University of Montreal Hospital (CHUM), Notre-Dame Hospital, Montreal, Quebec, Canada
^h Western Brittany Thrombosis Study Group — GETBO EA3878, Brest, France

^⁎Corresponding author at: Service d’Imagerie Médicale, CHU de la Cavale Blanche, boulevard Tanguy-Prigent, 29609 Brest, France.Service d’Imagerie MédicaleCHU de la Cavale Blancheboulevard Tanguy-PrigentBrest29609France

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Graphical abstract

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Highlights

•	This animal study analyzes the behaviour of a new liquid embolic agent in a swine model.
•	Magic glue (MG) achieved similar penetrations in rete mirabilis compared to NBCA.
•	MG required lower traction forces for microcatheter withdrawal with non-detachable tip.
•	The pressure cooker technique did not improve the extent of CYA penetration in this model.

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Abstract

Background

The pressure cooker (PC) technique uses a second microcatheter to produce a proximal occlusion to prevent the reflux of liquid embolic agent (LEA) injected through a more distal microcatheter, and can be used to treat arteriovenous malformations and dural arteriovenous fistulae. The liquid embolic Magic Glue (MG) (N-hexyl cyanoacrylate (NHCA)) has been introduced as an alternative to N-butyl cyanoacrylate (NBCA). Our goals were to compare the extent of embolization of rete mirabile with or without the PC technique using NBCA or MG, and to compare the proximal occlusions obtained with MG or NBCA while using the PC technique in a renal arterial model.

Methods

Rete mirabile were embolized with (n = 4) and without (n = 4) the PC technique, using MG (n = 4) or NBCA (n = 4). A renal arterial model was then used to study the characteristics of the MG plug (n = 10) used for the PC technique, and resistance to catheter withdrawal as compared to NBCA (n = 4). Specimens were analyzed macro- and microscopically and compared to angiographic results.

Results

Extent of rete embolization with CYA agents was not significantly greater when using the PC technique. Results were similar with both types of cyanoacrylate (p = 0.657). The force necessary to withdraw the microcatheter was less with MG than with NBCA (p = 0.035).

Conclusion

MG was similar to NBCA in extent of rete embolization. Less traction force was necessary to withdraw trapped non-detachable microcatheters using MG compared to NBCA.

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Keywords : Liquid embolic agents, AVM, Rete mirabile, Cyanoacrylates

Abbreviations : AVM, CYA, EVOH, LEA, PC, MG, NBCA