SIR 2024
Embolization
Henry T. Ruhl (he/him/his)
Student
Case Western Reserve University
Financial relationships: Full list of relationships is listed on the CME information page.
Felipe M. Berg (he/him/his)
MD/PhD Student
Case Western Reserve University
Financial relationships: Full list of relationships is listed on the CME information page.
Agata Exner, PhD (she/her/hers)
Henry Willson Payne Professor and Vice Chair for Basic Research
Case Western Reserve University
Disclosure information not submitted.
Foams were generated using two 10 mL syringes connected by a 3-way stopcock. One syringe was filled with room air, while the other contained 2 mL of sodium tetradecyl-sulfate (STS). The components were mixed through the stopcock 30 times (Tessari’s method). For contrast-bearing formulations, 1 mL of Lipiodol® (Guerbet, Villepinte, France) or Omnipaque® (Marlborough, United States) were added to the mixture (2mL of STS + 1mL of contrast). Each trial set encompassed ratios of 1:1.5, 2, 3, and 4 mL of STS to room air. Foam decay was monitored using a 4K camera over 1 hour, followed by hourly snapshots for 3 hours. Supplementary images were captured at the 24-hour mark if any foam persisted. Decay of foam was calculated using the formula (foam left in syringe)/(total volume).
Results:
Foam stability was significantly influenced by Lipiodol® and iodine contrast. When Lipiodol was combined with the air mixture, there was a 35-44% increase in foam stability for the 1:4 air to STS and 1:1.5 air to STS at 5 minutes, respectively. At 10 minutes, there was an average of 74% increase in foam remaining compared to foam made without contrast. We observed total foam decay in the air mixture at 30 minutes, while the Lipiodol mix had 84% foam remaining in the 1:1.5 and 47% foam remaining for the 1:4 ratio. Iodine contrast had a similar effect, but smaller in magnitude. At the 30 minutes mark, iodine contrast had 5 to 11% remaining for the 1:1.5 and 1:4 ratios, respectively. The trend continued at the 45 minute mark.
Conclusion: The introduction of Lipiodol highly increases the sclerosing foam stability whereas iodine contrast had similar but milder effect. These suggest that iodine contrast can be used to enhance contrast of sclerosing foam with mild enhancement of foam stability, whereas Lipiodol can provide contrast and significantly enhance stability.