Background

Endovascular embolization is an effective treatment option for cerebral arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs). A variety of liquid embolic agents have been and are currently used for embolization of AVMs and DAVFs. Knowledge of the special properties of the agent which is used is crucial for an effective and safe embolization procedure.

Material and Methods

This article describes the properties and indications of the liquid embolic agents which are currently available: cyanoacrylates (also called glues), and the copolymers Onyx, Squid and PHIL, as well as their respective subtypes.

Results

Cyanoacrylates were the predominantly used agents in the 1980s and 1990s. They are currently still used in specific situations, for example for the occlusion of macro-shunts, for the pressure cooker technique or in cases in which microcatheters are used that are not compatible with dimethyl-sulfoxide. The first broadly used copolymer-based embolic agent Onyx benefits from a large amount of available experience and data, which demonstrated its safety and efficacy in the treatment of cerebral vascular malformations, while its drawbacks include temporary loss of visibility during longer injections and artifacts in cross-sectional imaging. The more recently introduced agents Squid and PHIL aim to overcome these shortcomings and to improve the success rate of endovascular embolization. Novelties of these newer agents with potential advantages include extra-low viscosity versions, more stable visibility, and a lower degree of imaging artifacts.

Conclusion

All the available liquid embolic agents feature specific potential advantages and disadvantages over each other. The choice of the most appropriate embolic agent must be made based on the specific material characteristics of the agent, related to the specific anatomical characteristics of the target pathology.

中文翻译：

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胶水、玛瑙、鱿鱼还是菲尔？用于栓塞脑动静脉畸形和硬脑膜动静脉瘘的液体栓塞剂

背景

血管内栓塞是脑动静脉畸形（AVMs）和硬脑膜动静脉瘘（DAVFs）的有效治疗选择。多种液体栓塞剂已经并且目前用于 AVM 和 DAVF 的栓塞。了解所用药物的特殊性质对于有效和安全的栓塞手术至关重要。

材料与方法

本文介绍了目前可用的液体栓塞剂的特性和适应症：氰基丙烯酸酯（也称为胶水）和共聚物 Onyx、Squid 和 PHIL，以及它们各自的亚型。

结果

氰基丙烯酸酯是 1980 年代和 1990 年代主要使用的试剂。它们目前仍在特定情况下使用，例如用于大分流器的闭塞、用于压力锅技术或使用与二甲亚砜不相容的微导管的情况。第一个广泛使用的共聚物栓塞剂 Onyx 得益于大量可用的经验和数据，证明了其在治疗脑血管畸形方面的安全性和有效性，而其缺点包括在较长时间的注射过程中暂时失去可见性和交叉伪影截面成像。最近推出的药物 Squid 和 PHIL 旨在克服这些缺点并提高血管内栓塞的成功率。

结论

所有可用的液体栓塞剂都具有特定的潜在优势和劣势。最合适的栓塞剂的选择必须基于药剂的具体材料特性，与目标病理的具体解剖特征相关。