Calcium Alginate Provides a High Degree of Embolization in Aneurysm Models: A Specific Comparison to Coil Packing

Swarming self-adhesive microgels enabled aneurysm on-demand embolization in physiological blood flow

The recent rise of swarming microrobotics offers great promise in the revolution of minimally invasive embolization procedure for treating aneurysm. However, targeted embolization treatment of aneurysm using microrobots has significant challenges in the delivery capability and filling controllability. Here, we develop an interventional catheterization-integrated swarming microrobotic platform for aneurysm on-demand embolization in physiological blood flow. A pH-responsive self-healing hydrogel doped with magnetic and imaging agents is developed as the embolic microgels, which enables long-term self-adhesion under biological condition in a controllable manner. The embolization strategy is initiated by catheter-assisted deployment of swarming microgels, followed by the application of external magnetic field for targeted aggregation of microrobots into aneurysm sac under the real-time guidance of ultrasound and fluoroscopy imaging. Mild acidic stimulus is applied to trigger the welding of microgels with satisfactory bio-/hemocompatibility and physical stability and realize complete embolization. Our work presents a promising connection between the design and control of microrobotic swarms toward practical applications in dynamic environments.

Emerging Biomaterials-Based Strategies for Inhibiting Vasculature Function in Cancer Therapy

The constant feeding of oxygen and nutrients through the blood vasculature has a vital role in maintaining tumor growth. Interestingly, recent endeavors have shown that nanotherapeutics with the strategy to block tumor blood vessels feeding nutrients and oxygen for starvation therapy can be helpful in cancer treatment. However, this field has not been detailed. Hence, this review will present an exhaustive summary of the existing biomaterial based strategies to disrupt tumor vascular function for effective cancer treatment, including hydrogel or nanogel-mediated local arterial embolism, thrombosis activator loaded nano-material-mediated vascular occlusion and anti-vascular drugs that block tumor vascular function, which may be beneficial to the design of anti-cancer nanomedicine by targeting the tumor vascular system.

Embolization of Vascular Malformations via In Situ Photocrosslinking of Mechanically Reinforced Alginate Microfibers using an Optical-Fiber-Integrated Microfluidic Device

Embolization, which is a minimally invasive endovascular treatment, is a safe and effective procedure for treating vascular malformations (e.g., aneurysms). Hydrogel microfibers obtained via spatiotemporally controllable in situ photocrosslinking exhibit great potential for embolizing aneurysms. However, this process is challenging because of the absence of biocompatible and morphologically stable hydrogels and the difficulty in continuously spinning the microfibers via in situ photocrosslinking in extreme endovascular environments such as those involving a tortuous geometry and high absorbance. A double-crosslinked alginate-based hydrogel with tantalum nanopowder (DAT) that exploits the synergistic effect of covalent crosslinking by visible-light irradiation and ionic crosslinking using Ca2+ , which is present in the blood, is developed in this study. Furthermore, an effective strategy to design and produce an optical-fiber-integrated microfluidic device (OFI-MD) that can continuously spin hydrogel microfibers via in situ photocrosslinking in extreme endovascular environments is proposed. As an embolic material, DAT exhibits promising characteristics such as radiopacity, nondissociation, nonswelling, and constant mechanical strength in blood, in addition to excellent cyto- and hemo-compatibilities. Using OFI-MD to spin DAT microfibers continuously can help fill aneurysms safely, uniformly, and completely within the endovascular simulator without generating microscopic fragments, which demonstrates its potential as an effective embolization strategy.

Advances in Biomaterials and Technologies for Vascular Embolization

Minimally invasive transcatheter embolization is a common nonsurgical procedure in interventional radiology used for the deliberate occlusion of blood vessels for the treatment of diseased or injured vasculature. A wide variety of embolic agents including metallic coils, calibrated microspheres, and liquids are available for clinical practice. Additionally, advances in biomaterials, such as shape-memory foams, biodegradable polymers, and in situ gelling solutions have led to the development of novel preclinical embolic agents. The aim here is to provide a comprehensive overview of current and emerging technologies in endovascular embolization with respect to devices, materials, mechanisms, and design guidelines. Limitations and challenges in embolic materials are also discussed to promote advancement in the field.

An injectable shear-thinning biomaterial for endovascular embolization

Improved endovascular embolization of vascular conditions can generate better patient outcomes and minimize the need for repeat procedures. However, many embolic materials, such as metallic coils or liquid embolic agents, are associated with limitations and complications such as breakthrough bleeding, coil migration, coil compaction, recanalization, adhesion of the catheter to the embolic agent, or toxicity. Here, we engineered a shear-thinning biomaterial (STB), a nanocomposite hydrogel containing gelatin and silicate nanoplatelets, to function as an embolic agent for endovascular embolization procedures. STBs are injectable through clinical catheters and needles and have hemostatic activity comparable to metallic coils, the current gold standard. In addition, STBs withstand physiological pressures without fragmentation or displacement in elastomeric channels in vitro and in explant vessels ex vivo. In vitro experiments also indicated that STB embolization did not rely on intrinsic thrombosis as coils did for occlusion, suggesting that the biomaterial may be suitable for use in patients on anticoagulation therapy or those with coagulopathy. Using computed tomography imaging, the biomaterial was shown to fully occlude murine and porcine vasculature in vivo and remain at the site of injection without fragmentation or nontarget embolization. Given the advantages of rapid delivery, in vivo stability, and independent occlusion that does not rely on intrinsic thrombosis, STBs offer an alternative gel-based embolic agent with translational potential for endovascular embolization.

Microfluidic one-step fabrication of radiopaque alginate microgels with in situ synthesized barium sulfate nanoparticles

In this work, we report a new strategy to fabricate monodispersed radiopaque alginate (Ba-alginate) microgels by a one-step microfluidic method. Alginate droplets containing sulfate ions are first formed by a flow focusing microfluidic setup. These alginate droplets are subsequently solidified by barium ions in a collection bath. During the solidification process, excessive barium ions in the collection bath also react with sulfate ions in the alginate droplet, resulting in barium sulfate (BaSO(4)) nanoparticles in situ synthesized (acting as radiopaque imaging agents) within the Ba-alginate microgels. Scanning electron microscopy (SEM) combined with energy-dispersive X-ray spectroscopy (EDX) illustrate that 800 nm BaSO(4) nanoparticles are uniformly distributed inside the 30 μm Ba-alginate microgels, with 62 wt% of elemental barium (Ba). In addition, X-ray diffraction (XRD) measurements indicate that the BaSO(4) nanoparticles consist of 10 nm in situ synthesized BaSO(4) crystallites. The alginate microgels act as a soft and porous template to prevent the precipitation and aggregation of BaSO(4) nanoparticles. The Ba-alginate microgels are also visible under X-ray radiation. The facile route to fabricate alginate microgels as radiopaque embolic materials is of particular importance for endovascular embolization and localized diagnostic imaging applications. Similar approaches can also be adopted for synthesizing other inorganic nanoparticles in microgels.

In vitro delivery, cytotoxicity, swelling, and degradation behavior of a liquid-to-solid gelling polymer system for cerebral aneurysm embolization

This study examines the in vitro characteristics of a crosslinking polymer system for cerebral aneurysm embolization. The polymeric material is composed of poly(propylene glycol)diacrylate (PPODA) and pentaerythritol tetrakis(3-mercaptopropionate) (QT), formulated with the liquid contrast agents Conray™ or Omnipaque™ 300. The PPODA-QT system was tested for delivery feasibility through mock delivery into a model aneurysm. Cytotoxicity was performed by exposing 3T3 cells to gel formulations, followed by a cell viability assay. Swelling was measured on samples submerged in 150 mM phosphate buffered saline at 37 or 50°C. The same samples underwent compression testing to assess degradation, characterized by reduction in Young's modulus over time. The PPODA-QT system was easily deliverable to mock aneurysms. Cytotoxicity results indicated that Conray-formulated gels are initially less toxic than Omnipaque-formulated gels, but show greater susceptibility to swelling and degradation over time. In general, these experiments represented more challenging conditions than would be present in vivo, and therefore, reported results are likely overestimations of in vivo outcomes. However, these results highlight potential issues with each PPODA-QT formulation. Given the desired outcome of neointimal tissue growth over the polymer material, initial cytotoxicity may be more important than long-term factors when choosing an optimal formulation for aneurysm embolization.

In vivo experimental aneurysm embolization in a swine model with a liquid-to-solid gelling polymer system: initial biocompatibility and delivery strategy analysis

OBJECTIVE

Current treatments for cerebral aneurysms are far from ideal. Platinum coils are prone to compaction, and currently used liquid embolics are delivered with angiotoxic agents. This work presents initial in vivo studies of a novel liquid-to-solid gelling polymer system (PPODA-QT), focusing on biocompatibility and effective delivery strategies.

METHODS

PPODA-QT was used to embolize surgically created lateral wall carotid artery aneurysms in swine using three delivery strategies. Group 1 aneurysms were completely filled with PPODA-QT (n = 5), group 2 aneurysms were subcompletely (80%-90%) filled (n = 3), and group 3 aneurysms underwent three-dimensional coil placement followed by polymer embolization (n = 3). The study was designed such that three animals per treatment group survived to 1 month.

RESULTS

The group 1 delivery strategy (100% filling) resulted in survival of 3/5 animals. This strategy led to aneurysm stretching, which resulted model failure in 2/5 animals. Group 2 aneurysms, although initially <100% filled with the polymer, displayed robust neointimal tissue coverage and complete obliteration after 1 month. Group 3 aneurysms showed less prominent neointimal tissue coverage as well as two instances where excess polymer was found in the parent vessel. The PPODA-QT material showed good biocompatibility with vascular tissue in all animals at 1 month.

CONCLUSIONS

This small-scale pilot study highlighted first-time in vivo use of PPODA-QT as an embolic agent for aneurysm treatment. Filling aneurysms to 80% to 90% capacity proved to be a safe and effective delivery strategy, and PPODA-QT showed excellent biocompatibility. This study indicates that future investigation of PPODA-QT for aneurysm embolization is warranted, as it may prove to be a viable alternative to current embolic materials.

Assessment of EmboGel--a selectively dissolvable radiopaque hydrogel for embolic applications

PURPOSE

To evaluate the embolic properties of an alginate-based embolic biomaterial (EmboGel) and its solvent (EmboClear) in treatment of aneurysms.

MATERIALS AND METHODS

EmboGel is a mixture of iohexol and alginate that polymerizes into a hydrocoil when delivered through a coaxial catheter with a distal mixing tip, exposing alginate to a calcium chloride solution. In contrast to previously reported embolic agents, EmboGel can be selectively dissolved by EmboClear, a mixture of the enzyme alginate lyase and ethylenediaminetetraacetic acid (EDTA). The embolic and contrast properties of EmboGel were assessed in in vitro models of saccular aneurysm and an aortic aneurysm endoleak. The dissolvability of EmboGel with EmboClear was assessed further after endovascular delivery in the New Zealand white rabbit in the native aortoiliofemoral territory, a created saccular aneurysm, and the native carotid arteries.

RESULTS

EmboGel effectively filled aneurysm cavities in the case of stent excluded saccular and fusiform aneurysms. EmboGel was readily dissolved by EmboClear in vitro and after in vivo embolization. When the distal abdominal aorta and pelvic arteries were occluded with EmboGel, within 1 minute of EmboClear infusion, patency of the aorta and most of the pelvic circulation was regained as noted by angiography. Embolization in the subclavian artery and numerous distal branches was rapidly dissolved by EmboClear. Finally, the carotid artery occluded with EmboGel regained patency after administration of EmboClear.

CONCLUSIONS

EmboGel is a dissolvable alginate-based biomaterial that can be used for numerous embolic applications. EmboGel can be selectively dissolved with EmboClear, a solution of alginate lyase and EDTA.

A gel-forming poly-L: -guluronic acid produced from no guluronate-rich marine algae using new hydrolysis method: test for endovascular embolization

To prepare a gel-forming poly-L-guluronic acid (Poly-G) from no guluronate-rich Laminaria japonica, a new hydrolysis method was employed with a lower HCl concentration (0.025-0.15 M) and a shorter treatment time (5 min). The Poly-Gs were set to measure purity, presence of poly-L-guluronic block, molecular weight distribution, polymer yield, viscosity, and compressive gel strength. Finally, the Poly-G was tested to embolize the renal vascular system by using a rabbit model and angiography. Optimized Poly-G could be selected with respect to wt% concentration, polymer yield, gel-forming stability, viscosity, and gel strength as an endovascular embolizing agent. Overall, 0.4-0.6% of 0.03 M-Poly-G obtained from acid treatment with 0.03 M of HCl had molecular weights greater than 80 kDa, and the best gelling capacity with an injectable viscosity (30-120 cP). It was successfully delivered into the vascular bed of a rabbit kidney and was shown angiographically to embolize the renal vascular system.

Preliminary investigation of calcium alginate gel as a biocompatible material for endovascular aneurysm embolization in vivo

OBJECTIVE

We sought to expand our assessment of calcium alginate as an embolic agent in an aneurysm model in swine that survived from 30 to 90 days. The objective of this study was to assess the biocompatibility and stability of calcium alginate in aneurysms in vivo.

METHODS

Ten models were created from a venous pouch sutured to the carotid artery, simulating flow to a side-wall aneurysm. Eight swine received complete embolizations, and two were less than 50% embolized to be used as controls. Alginate and calcium chloride were injected from concentric-tube microcatheters to form a mass that filled the aneurysm pouch.

RESULTS

Angiography and histology verified complete aneurysm occlusion and neck healing up to 90 days in eight swine. Both control animal aneurysms ruptured within 8 days. No animals showed evidence of downstream calcium alginate gel propagation. A minor bioactive response to the alginate gel was noted at 30 days, and fibrous tissue grew over the aneurysm orifice, sealing off the defect. No degenerative or inflammatory response was observed. At 90 days, moderate fibrous tissue surrounded the alginate. Tissue growth across the aneurysm neck remained complete and stable with no signs of neointimal growth into the parent vessel.

CONCLUSION

Calcium alginate was an effective endovascular occlusion material that filled the aneurysm and provided an effective template for tissue growth across the aneurysm neck after 30 days and up to 90 days. Complete filling of the aneurysm with calcium alginate ensures stability, biocompatibility, and optimal healing for up to 90 days in swine.

Controlling delivery properties of a waterborne,in-situ-forming biomaterial

This study details efforts to transition an in-situ-gelling polymer for endovascular embolization from the bench-top to preclinical cerebral arteriovenous malformation animal model studies. The in-situ-forming gel is based on waterborne, reverse emulsion materials. For controlled embolization of vascular defects, it is crucial to understand the delivery properties of an in-situ-forming gel. Directing a liquid into a small cavity requires both precise control of the fluid flow, and depends upon minimal variability in the materials behavior. A 2(3) factorial experiment performed in the laboratory revealed that temperature, mixing time, and buffer strength are all significant factors affecting the gelation time of the specific system studied. All three factors were also seen to reduce the standard deviation on the gel times. Changing the temperature from 21.3 to 37.0 degrees C reduced the cross population variability from 6.0 +/- 3.3 min to 3.4 +/- 1.6 min. At 30-s premixing, the protocol produced an average gel time of 5.3 +/- 3.0 min, which was reduced to 3.3 +/- 1.2 min with 90 s. Finally, a 50 mM buffer solution provided a gel time of 6.5 +/- 3.2 min, which was reduced to 2.95 +/- 0.6 min at 100 mM. Viscosity data was analyzed to suggest a model for injection volume and viscosity.

Calcium alginate gel as a biocompatible material for endovascular arteriovenous malformation embolization: six-month results in an animal model

OBJECTIVE

We sought to expand our assessment of calcium alginate as an embolic agent in an animal model of a cerebral arteriovenous malformation (AVM). The objective of this study was to assess the long-term biocompatibility and stability of calcium alginate in AVM swine models that survived from 1 to 6 months.

METHODS

The swine model included a carotid-jugular anastomosis to redirect flow to the rete mirabile (RM), thereby simulating flow to an AVM. Alginate and the reactive component, calcium chloride, were injected from double-lumen or concentric-tube microcatheters to form an occlusion of the RM feeding vessel and the inferior portion of the RM.

RESULTS

Angiography and histology verified complete occlusion of the RM feeding vessel for up to 6 months in eight of nine swine. Blood flow remained open to the superior portion of the RM and the circle of Willis. No evidence of downstream calcium alginate gel was seen in the follow-up angiograms or the histological preparations of the circle of Willis. A minor bioactive response to the alginate gel was noted at 1 month, yet no degenerative or inflammatory response was seen. At 6 months, there was moderate fibrous tissue around the alginate, which further sealed off flow to the embolized areas of the RM.

CONCLUSION

Over a period of 6 months, calcium alginate was an effective endovascular occlusion material that blocked blood flow to the inferior portion of the RM. The chronic AVM model verified the long-term stability and biocompatibility of calcium alginate.