1. NBCA Embolization for Vascular Disease in Central Nervous System
Department of Radiology, Ohashi Medical Center Toho University
Yuo Iizuka, Mikiko Iwasaki, Minako Ooka, Miki Sugiyama, Makoto Hasegawa
Nozomu Murata, Asako Kato, Toshiyuki Kunihiro, Tatuya Gomi, Masashi Nagamoto, Eiichi Kohda
N-butyl-cyanoacrylate is liquid adhesive non-absorbable embolic material whose permeability is very stable. Such materials must be liquid at the time of injection and should solidify when they reach the pathological angioarchitecture, producing an endovascular cast of the area without passing into the venous circulation or distal arterial territory. If superselectivity is accomplished and no normal or endangered vessels are present, one can inject acrylic as a continuous column to produce an intravascular cast. An important part of the management of angioma is educating the patient. NBCA embolization for arteriovenous malformation can be carried out as a unique treatment, the intended goal being partial and targeted, palliative, curative, or in combination with surgery or stereotactic radiosurgery. It may be given as elective treatment or in emergent fashion, depending on the indication and circumstances. The indication to use this embolic material should be well considered in the clinical management of angioma and the arteriovenous malformation in the central nervous system.
- Interventional Radiology
- Central nervous system
- Arteriovenous malformation
2. N-butyl Cyanoacrylate Embolization for Control of Acute Gastrointestinal Hemorrhage
Department of Radiology, San-in Rosai Hospital
Department of Radiology, Tottori University Hospital
Although most cases of acute gastrointestinal（GI）bleeding are managed by conservative or endoscopic treatment, there are still some patients who should receive more aggressive treatment. Transcatheter arterial embolization has been widely accepted for the treatment of life threatening acute upper and lower GI bleeding. Although the development of microcatheters and microcoils has enabled us to perform more distal embolization, it may be sometimes difficult to advance the microcatheter to the bleeding point because of vascular tortuosity and also to achieve complete hemostasis in patients with coagulopathy. N-butyl cyanoacrylate（NBCA）allows rapid and permanent embolization just after contact with blood and achieves complete hemostasis with the collateral vessels occlusions. NBCA embolization takes less time than conventional coil embolization and can prevent recurrent bleeding with a low risk of critical gastrointestinal ischemia, especially when the patient has an unstable hemodynamic state because of massive bleeding. Interventional radiologists should be familiar with the use of NBCA preparing for such a serious condition.
- Gastrointestinal bleeding
3. Spherical Embolic Agents
Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
Keigo Osuga, Noboru Maeda, Hiroki Higashihara, Kaname Tomoda, Noriyuki Tomiyama
Department of Medical Technology, Division of Radiology, Osaka University Hospital
Department of Diagnostic Radiology, National Cancer Center
Department of Radiology, National Cardiovascular Center
Gatetower Institute for Image Guided Therapy
Gelatin sponge and polyvinyl alcohol particles have been the most popular particulate embolic agents for hypervascular tumors, arterial bleedings and vascular malformations. Over the last decade, calibrated microspheres have been introduced and increasingly used especially in uterine fibroid embolization in Western countries. In addition, drug-eluting microspheres have been applied for liver tumor embolization. The advantages of these microspheres are that particles are uniform in size and shape, and easy to inject through a microcatheter. They can travel distally to vessels corresponding to the particle size ; in other words, the occlusion level can be predictable according to the particle size chosen. However, there are also pitfalls associated with the use of microspheres. Temporary aggregation and redistribution of microspheres may allow resumption of the blood flow of once apparently occluded vessels. Microspheres with low elasticity and rigidity may migrate more distally than desired due to particle deformation. The mechanical properties of drug eluting beads may alter upon drug loading and release. Therefore, we need to understand the behavior of each type of microsphere to obtain the optimal embolic effects. It is also important to investigate the true benefits of microspheres or in what pathological conditions they will improve the safety and efficacy compared to the conventional materials.
- Embolic material
4. Metallic Coil
Department of Radiology, Nara Medical University
Hiroyuki Nakagawa, Takeshi Wada, Hiroshi Anai, Satoru Sueyoshi, Kimihiko Kichikawa
Department of Radiology·IVR center, Daiyukai General Hospital
Takeshi Nagata, Hideo Uchida
Transcatheter arterial embolization（TAE）is an important technique in Interventional radiology（IVR）, and metallic coils play an important role as an embolic material. Coil was developed by Dr. Ceaser Gianturco in 1975, and was introduced to Japan by COOK/Medicos Hirata 35 years ago. So far various types of coil have been developed and become remarkably wide spread. They are an essential medical device in IVR as a less invasive therapy. Coils are available in a wide variety of sizes and shapes, which are made from either stainless steel or platinum and may have Dacron fibers placed. Indications of coil include embolization of aneurysm, arteriovenous malformation, arteriovenous shunt, vascular lesions causing massive hemorrhage and alteration of blood supply before chemoinfusion therapy. It is very important to understand the kinds, size, shape, and features of coils and to select the appropriate coil for each organ and lesion. Interventional radiologists are required to gain special techniques and knowledge about coils to achieve a good therapeutic effect without complications. This article reports fundamental knowledge about coils with presentation of clinical cases in various organs and diseases.
- Metallic coil
5. Gelatin Sponge
Department of Radiology, Wakayama Medical University
Isao Takasaka, Nobuyuki Kawai, Morio Sato, Motoki Nakai, Hiroki Minamiguchi, Tetsuo Sonomura
Gelatin sponge particles have been used as embolic materials for more than 30 years. This embolic material has wide therapeutic applications such as chemoembolization for hepatocellular carcinoma, bleeding control and embolization of other malignant tumors, benign tumor, trauma, and gastrointestinal bleeding. This article aimed to provide information on the characteristics of gelatin sponge, role of embolic material, and method of creation of gelatin sponge. We also describe our clinical experience with soluble gelatin sponge for transcatheter chemoembolization.
- Gelatin sponge
- Embolic material
- Soluble gelatin sponge