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Background: The aim of this study was to understand physical characteristics of Embosphere microspheres for the clinical use of microsphere chemotherapy embolization of liver cancer. Methods: The morphology of Embosphere microspheres in different states, including static, oscillating, and in a magnetic field was observed with the naked eye. Ninety-five patients diagnosed with primary hepatocellular carcinoma (HCC) were separated into 3 groups based on the types of embolic material as follows: 32 cases of sole microspheres, 34 cases of iodinated oil (17 cases with additional application of gelatin sponge particle), and 29 cases of iodinated oil + Embosphere microspheres. Results: The diameter of the microspheres ranged from 100 to 300 μm, with a sedimentation rate υ = 0.0375 cm/s in physiological saline. The diameter of microspheres ranged from 300 to 500 μm, with a sedimentation rate υ = 0.1875 cm/s. The swelling rate of microspheres was 90%. Microspheres showed nondirectional movement in a 1.5- or 3.0-T magnetic field during magnetic resonance imaging. A volumetric ratio of 1:1.4–1:1.5 between microspheres and contrast agent resulted in optimal suspension properties. Microspheres appeared circular with a smooth surface upon water adsorption. Microsphere embolism was observable in blood vessels of pathological sections. The surface of microspheres can adsorb 5-fluorouracil and arsenic trioxide. There are statistically significant differences in local-regional tumor control conditions among patients treated with sole microspheres, iodinated oil, and iodinated oil + microspheres during transarterial chemoembolization. Conclusions: Embosphere microspheres can be used to embolize patients with rupture and hemorrhage of HCC. Embosphere microsphere embolization is superior to iodinated oil and iodinated oil + microsphere for HCC.

PURPOSE To compare procedural metrics and clinical improvement for prostatic artery embolization (PAE) performed with a balloon-occlusion (BO) versus end-hole (EH) microcatheter in patients with benign prostatic hyperplasia. MATERIALS AND METHODS Retrospective review was performed of 129 patients undergoing PAE with 100-300 μm Embosphere microspheres from April 2013 through August 2018. Microcatheter selection was nonrandom, based on prostatic artery anatomy. Five technical failures and 5 microcatheter crossover cases were excluded. BO group (n = 46, age 72.8 y ± 9.0, gland volume 184 mL ± 83, 42% in retention) and EH group (n = 73, age 76.0 y ± 9.0, gland volume 190 mL ± 116, 44% in retention) were compared using procedural metrics (excluding 30 EH learning-curve cases); symptomatic improvement at 3, 6, and 12 months after PAE; voiding trial success; and adverse events (reported used Clavien-Dindo classification). RESULTS Procedural and fluoroscopy times were lower in the BO group (n = 46) vs EH group (n = 43) (152.0 min ± 34.0 vs 172.8 min ± 47.9, P < .02; 37.8 min ± 12.9 vs 50.3 min ± 18.9, P < .001). Collaterals coiled, contrast material used, and injected particle volume were similar for both groups (P = NS). International Prostate Symptom Score improvement was similar for BO group (n = 25) (before PAE 23.5 ± 6.5, 12 months after PAE 7.6 ± 6.8) and EH group (n = 30) (before PAE 20.9 ± 5.9, 12 months after PAE 6.6 ± 5.2) (P = NS). Quality-of-life improvements were also similar (BO: before PAE 4.5 ± 1.2, 12 months after PAE 1.4 ± 0.9; EH: before PAE 4.1 ± 1.0, 12 months after PAE 0.9 ± 0.7), as were 12-month postvoid residual improvements, voiding trial failure rates (EH 12%, BO 8%), and adverse event rates (grade II, III: EH 15%, BO 11%) (P = NS for all). CONCLUSIONS BO microcatheter use in PAE did not affect injected particle volume, contrast material use, or protective coiling and did not impact symptomatic improvement, postvoid residual improvement, voiding trial success, or adverse events after PAE. Lower procedure and fluoroscopy times with BO microcatheter were likely due to selection bias.

Transarterial embolization (TAE) can be used to treat unresectable and unablatable liver-dominant metastases from neuroendocrine tumor (NET) and sarcoma. TAE could also potentially be used to treat liver metastases from other primaries, but data on efficacy is limited outside of NET and sarcoma. For hepatocellular carcinoma, NET, and sarcoma, outcomes after TAE and transarterial chemoembolization are similar, suggesting that ischemia is the dominant mechanism causing tumor necrosis. For colorectal cancer liver metastases, transarterial chemoembolization using irinotecan-loaded drug-eluting beads improves overall survival. For NET liver metastases, arterial therapy is generally reserved for patients with progressive liver metastases who are either symptomatic or have a large tumor burden. Asymptomatic small-volume NET liver metastases can be followed and typically do not need to be embolized immediately. Generally, TAE (lobar or selective) is performed starting with 40–120-micron Embosphere microspheres (Merit Medical, South Jordan, UT) (up to five syringes), followed by 100–300-micron Embospheres. The endpoint for embolization is stasis.

The malignant phyllodes tumor is a relatively rare neoplasm and has not previously been a therapeutic target of interventional radiology. Herein, we report a successful case of preoperative chemoembolization of a giant malignant phyllodes tumor. The objective was to achieve sufficient tumor shrinkage before surgery to avoid the requirement for skin grafting after resection. Intra-arterial epirubicin infusion and subsequent embolization with Embosphere Microspheres (BioSphere Medical, Rockland, MA, USA) was undertaken three times over the course of 6 weeks and was well tolerated. The patient underwent surgery without skin grafting. Neither local recurrence nor distant metastasis was observed at 6 months after surgery.

A 51-year-old left-handed woman developed acute hemoptysis. The day after admission, her bronchoscopy showed active bleeding in the apical segment of the right upper lobe. Pulmonary angiography showed a small vascular lesion in the apex. The right bronchial artery was embolized using 300- to 500-μm Embosphere microspheres and three 2 × 10–mm coils. The patient had a headache the following day. Noncontrast CT showed multiple hypodensities in the cerebellum. Follow-up MRI showed multiple areas of …

Background To reduce intraoperative bleeding and to facilitate surgery by inducing tumor softening, a preoperative embolization of meningiomas is commonly recommended. Patients and methods We report on our experience with non-resorbable microspheres (Embosphere) in the preoperative endovascular embolization of 17 intracranial meningiomas. After adding contrast media to the particles sized 40-500 micron, the embolization process was followed under fluoroscopy. There was a good passage of microcatheters if high concentrations of particles were avoided. Results The obstruction of the tumor feeders by particles was accompanied by a regression of tumor blush in DSA. CT controls showed a diminished contrast accumulation of the tumors already 1-2 days after embolization. Histologically, Embosphere microspheres were easy detectable with all commonly used staining methods. Embolization triggered, microscopically detectable necrosis was found in 77 % of the tumors. The mean interval between embolization and tumor extirpation was 2.5 days. The average time required for tumor extirpation was 244 minutes, while the average blood loss was 749 ml. Conclusions Our experiences show that Embosphere microspheres are effective embolic agents in obstructing meningeal feeders of preoperatively treated meningiomas.

Introduction: In order to select appropriate candidates for treatment of uterine fibroids using MR guided focused ultrasound (MRgFUS), a careful review of the patients' history and imaging is required. Not infrequently, patients with uterine fibroids seeking MRgFUS have previously undergone uterine artery embolization (UAE). The most common embolic agent used during UAE is Embosphere microspheres (Merit Medical Systems, INC, South Jordan, UT). Following UAE, the microspheres remain in the capillary beds of the fibroid vessels indefinitely. However, little is known regarding the nature of Embosphere microspheres in the setting of elevated temperatures (65–85degrees C) generated by high intensity focused ultrasound (HIFU). Embosphere microspheres are made of an acrylic co‐polymer (trisacryl), which is cross‐linked with gelatin. The aim of the present study was to evaluate for changes in Embosphere microspheres that underwent HIFU. Purpose: To evaluate for changes in shape and nature of Embosphere microspheres following MRgFUS.Materials and Methods: 10cc of 500–700micron Embosphere microspheres were injected into chicken breast. HIFU thermal ablation was performed, reaching high enough temperature to coagulate the chicken breast surrounding the microspheres. Additionally a vial containing microspheres was placed in a bath of heating water and temperature monitoring was performed until a maximum temperature of 100 degrees C. Gross and microscopic evaluation of the microspheres following HIFU and waterbath heating was performed. Results: The microspheres maintained their normal structure without evidence of denaturing or melting when targeted directly with HIFU (Figure 1). Additionally, the microspheres in boiling water did not alter their shape and structural integrity (Figure 2). Conclusion: HIFU of Embosphere microspheres does not change the structural integrity of the particles. As such, in the setting of prior UAE with Embosphere microspheres, MRgFUS may be safe without inducing particle denaturing or melting.