Evaluating thermosensitive chitosan/ β-glycerophosphate sodium and fibroblast embolization for the treatment of cerebral arteriovenous malformation in a porcine model.

OBJECTIVE: To evaluate the feasibility of non-sticky thermosensitive liquid embolic material chitosan/β-glycerophosphate sodium (C/GP) and fibroblast embolization in rete mirabile (REM) for preparing the model of cerebral arteriovenous malformation (cAVM); to study the method of microcatheter injection of C/GP-gel system; and to observe the embolization effect and histological changes of REM.

METHODS: A total of 26 domestic pigs were grouped and prepared designed models, followed by different treatment methods using C/GP. C/GP embolization of the REM were performed. The brain samples were obtained after week 6's angiography and finally, subjected to H&E staining for histological examination.

RESULTS: In 26 pig models, 25 pigs were successfully modeled, and 1 pig had convulsions and died during the modeling process. After embolization, angiography showed that the embolized REM was no longer developed while there was no adhesion between the tip of the microcatheter and the embolization agent. No recanalization was found in week 2 and week 6's angiography. Histological examination: the hydrogel was uniformly dispersed in REM, and REM was completely embolized. The texture was hard. REM was filled by gel and fibroblasts, the intima of the wall was clearly visible, and the smooth muscle layer was intact. No exfoliation and necrosis of the vessel wall were observed, and no inflammatory reaction was observed around the blood vessel.

CONCLUSIONS: Our study provided sufficient evidence to suggest that C/GP may be a novel liquid embolic material for the endovascular treatment of cAVM. C/GP and fibroblasts can be used in the embolization of cAVM and may have broad application as an ideal embolization material for the treatment of cAVM.