Precipitating hydrophobic injectable liquid embolization of intracranial vascular shunts: initial experience and technical note

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Precipitating hydrophobic injectable liquid (PHIL) is a newly available liquid embolic agent for endovascular therapy. It is nonadhesive and composed of a biocompatible polymer dissolved in dimethyl sulfoxide solvent and bonded covalently with iodine.

In this report, the authors present their preliminary experience using PHIL in the treatment of intracranial vascular shunts. Between July 2015 and December 2015, 11 patients underwent endovascular embolization using the PHIL embolic agent. Five patients had arteriovenous malformations, 4 had dural arteriovenous fistulas, 1 patient had a carotid-cavernous fistula, and 1 patient had a pial arteriovenous fistula. Clinical features, angioarchitectural characteristics, procedural details, and periprocedural complications were included in the analysis.

Complete or near-complete obliteration of the nidus or fistulas was achieved in 8 of these patients. Partial embolization (approximately 80% in 2 and 30% in 1) was attained in the other 3 patients. Satisfactory venous penetration after nidal embolization was achieved in all patients. In 1 patient, the microcatheter could not be retrieved. No other major complications related to PHIL injection were noted during the procedure or periprocedural period. Clinical follow-up ranging from 8 months to 1 year showed good outcomes in all but 1 patient, who experienced an intraventricular hemorrhage 6 weeks after embolization.

PHIL appears to be an effective alternative embolic material with certain advantages over other available liquid embolic agents. Further studies with adequate follow-up are required to fully evaluate its safety and efficacy.

ABBREVIATIONS AVF = arteriovenous fistula; AVM = arteriovenous malformation; CCF = carotid-cavernous fistula; DAVF = dural AVF; DMSO = dimethyl sulfoxide; NBCA = N-butyl cyanoacrylate; PHIL = precipitating hydrophobic injectable liquid.
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Contributor Notes

Correspondence Arvinda Hanumanthapura Ramalingaiah, Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India. email: aravind.radiology@gmail.com.INCLUDE WHEN CITING Published online December 1, 2017; DOI: 10.3171/2017.6.JNS16447.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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References
  • 1

    Choo DMShankar JJ: Onyx versus nBCA and coils in the treatment of intracranial dural arteriovenous fistulas. Interv Neuroradiol 22:2122162016

  • 2

    Cognard CGobin YPPierot LBailly ALHoudart ECasasco A: Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194:6716801995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Koçer NHanımoğlu HBatur ŞKandemirli SGKızılkılıç OSanus Z: Preliminary experience with precipitating hydrophobic injectable liquid in brain arteriovenous malformations. Diagn Interv Radiol 22:1841892016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Leyon JJChavda SThomas ALamin S: Preliminary experience with the liquid embolic material agent PHIL (precipitating hydrophobic injectable liquid) in treating cranial and spinal dural arteriovenous fistulas: technical note. J Neurointerv Surg 8:5966022016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Natarajan SKBorn DGhodke BBritz GWSekhar LN: Histopathological changes in brain arteriovenous malformations after embolization using Onyx or N-butyl cyanoacrylate. Laboratory investigation. J Neurosurg 111:1051132009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Samaniego EAKalousek VAbdo GOrtega-Gutierrez S: Preliminary experience with precipitating hydrophobic injectable liquid (PHIL) in treating cerebral AVMs. J Neurointerv Surg 8:125312552016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Spetzler RFMartin NA: A proposed grading system for arteriovenous malformations. J Neurosurg 65:4764831986

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