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Jean-Pierre Pelage, MD PhDpelage-jp@chu-caen.fr
GEST 2016 US, New-York
Spherical Embolics:
So Many Choices So Little Time
Jean-Pierre Pelage, M.D., Ph.D.
• Consultant/Advisory Board: Merit Medical, Terumo, ALN, Cook Medical,Guerbet, Boston
Scientific
• Research Grants: BTG, Terumo, ALN
Embolic Microspheres (Non resorbable)
Calibrated microspheres
Allow targeted devascularization / occlusion
Injectable through microcatheters (even large sizes)
Different presentations: visible, syringe, …
Different properties
Specific instructions for use
How to make your choice?
Embolization Microspheres
Hydropearl
Embozene
Presentation
• Prepacked syringes (1 or 2 mls) vs vials
• Visible:
- blue: Bead Block
- transparent: Embosphere (purple: EmboGold)
- color-coded by size: Embozene or Hydropearl
• Calibration (granulometric distribution):
- Range of sizes (300-500 µm): Bead Block and
Embosphere
- Narrow calibration (600 µm): Embozene and Hydropearl
Granulometric Distribution
700-900 µm Product A
Characteristics
• Compressibility = ability to be compressed (microcatheter,
vessel)
Compressibility > 30% = ability of 700-900 µm
microspheres to be injected through a >.025 ID microcatheters
>30% risk of rupture except soft microspheres
• Elastic recovery = time required to get back to its initial
spherical shape
Slow recovery = distal traveling
Before compression 30% compression Sudden Release
Soft product
Rigid product
Compression / Decompression Test
Tris-Acryl Microspheres
Embosphere,
Merit Medical (Biosphere Medical)
Mechanisms of Occlusion
Spherical particles
No aggregates
Complete lumen occlusion
Various Clinical Indications
and Long-Term Tolerance
6 years
1 year
Facial AVM
Intravascular Location of Embolic Particles
Pre-operative Embolization of Meningiomas
0%
10%
20%
30%
40%
50%
60%
70%
absent arteriolar capillar
MS 100-300µm
PVA 45-150µm
PVA 150-250µm
Bendszus. AJNR 2000;21:255-61
Embolization of the Sheep Uterus
Diameter of occluded arteries (µm)
ES
100/3
00
ES
300/5
00
ES
50
0/7
00
ES
700/9
00
0
100
200
300
400
500
600
Dia
mete
rof
art
eries
(µm
)
Pelage, et al. Radiology 2002;224:436-45
Acrylamido-PVA microspheres
Bead Block, BTG (Biocompatibles)
Compressibility Evaluation (900-1200µm)
(Mean SD - 5 samples)
Déformation (%)-5
0
5
10
15
20
25
30
35
40
0% 10% 20% 30% 40% 50% 60% 70% 80%
Embosphere
BeadBlock
Contour
Force (g)
Acrylamido-PVA Microspheres
• Bead Block 700-900 µm is equivalent to
500-700 µm tris-acryl microspheres
PMMA hydrogel with polyzene F coating
Embozene, Boston Scientific (Celonova)
Embozene
Embozene
Embozene
• Non-resorbable
• Spherical
• Compressible
• Easy to inject (microcatheter)
• Very narrow calibration (600µm
≠ 500-700 µm)
• Microspheres color-coded
• Very compressible
• Specific technique of use
≠ tris-acryl MS
• Secondary redistribution
Deformation Embosphere vs Embozene
Embozene Embosphere
Top Tips
Because more compressible than
Embospheres, consider upsizing for safety
i.e. Embozene 900 µm recommanded for
uterine fibroid embolization
Secondary redistribution more significant
PolyEthlyleneGlycol (PEG) Microspheres
Hydropearl, Microvention-Terumo
Hydropearl
75µm
400µm
600µm
800µm 1,100µm200µm
Hydropearl
• Non-resorbable
• Spherical
• Compressible
• Easy to inject (microcatheter)
• Very narrow calibration (600µm
≠ 500-700 µm)
• Microspheres color-coded
• Compressibility?
• 800 µm recommanded
for uterine fibroid
embolization
• Just released in Europe
(november 2015)
Conclusion
Calibrated microspheres
Easy to handle
Easy injection of large microspheres through
microcatheterswithout clugging
Targeted embolization achievable
Conclusion
Be aware of mechanical differences between
products (trisacryl vs PVA vs PEG, …)
Extensive data available with Embosphere
Limited data at this point with Embozene and
Hydropearl
Future of particulate embolization: drug-eluting,
imaging detectable, resorbable, …
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