In vivo revascularization and tissue effects of uterine artery embolization with starch microspheres in sheep

Issue title: Selected articles of the 42th Conference of the German Society for Clinical Microcirculation and Hemorheology, 15–16 November 2024, Senftenberg, Germany

Guest editors: S. Braune and F. Jung

Article type: Research Article

Authors: Hinestrosa, Camila A.^a | Fuchs, Jochen^b | Denecke, Timm^a | Storch, Christiane^c | Dreyer, Antje^c | Kuthning, Anja^d | Reinhardt, Martin^e | Rio Bartulos, Carolina^f | Wiggermann, Philipp^f | Busse, Harald^{a; 1} | Moche, Michael^{b; 1; *}

Affiliations: [a] Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany | [b] Helios Park-Klinikum Leipzig, Leipzig, Germany | [c] Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany | [d] PharmaCept GmbH, Berlin, Germany | [e] Zentrum für Radiologie und Nuklearmedizin am Johannisplatz, Leipzig, Germany | [f] Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig gGmbH, Braunschweig, Germany

Correspondence: [*] Corresponding author: Michael Moche, Helios Park-Klinikum Leipzig, Strumpellstraße 41, 04289 Leipzig, Germany. E-mail: Michael.Moche@helios-gesundheit.de.

Note: [1] These authors contributed equally to the manuscript.

Abstract: OBJECTIVE:In uterine artery embolization (UAE) for the treatment of fibroids, nondegradable particles permanently occlude the uterine artery (UA). These particles remain in the vessels and can cause secondary undesirable effects, such as severe pain after embolization and fertility issues. In this prospective experimental study, we aimed to evaluate the angiographic recanalization, local and systemic reactions, and uterine damage occurring after performing UAE with newly developed degradable starch microspheres (DSMs) in sheep. MATERIALS AND METHODS:Under general anesthesia, eight nonpregnant sheep underwent bilateral UAE using DSMs to achieve stasis. Angiographic evaluation was performed on days 1, 3 and 7 after embolization to assess in vivo recanalization. In addition, the angiographic series were scored via a modified embolization score. A postmortem tissue examination was performed to determine whether DSMs and foreign body inflammatory reactions were present and to assess uterine necrosis. RESULTS:Complete bilateral embolization of the UA and cervicovaginal branches was achieved in all treated animals. Recanalization of the occluded arteries was evident in 25 of 27 arteries during the angiographic evaluation. In all sheep, there were multifocal areas of uterine necrosis, and some uterine vessels contained intraluminal material consistent with DSMs. The average weight of both uterine horns was significantly correlated with both the number of microspheres needed for complete embolization (r = 0.69, ρ<0.01) and the average percentage of necrosis in both uterine horns (r = 0.64, ρ<0.05). CONCLUSIONS:Our findings demonstrated the efficacy of vascular embolization with DSM by inducing ischemic changes in the uterus and subsequent recanalization of previously occluded arteries.

Keywords: Uterine artery embolization, degradable starch microspheres, animal models, angiography, leiomyoma

DOI: 10.3233/CH-248106

Journal: Clinical Hemorheology and Microcirculation, vol. 88, no. s1, pp. S69-S84, 2024