US 2012O184642A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2012/0184642 A1 Bartling et al. (43) Pub. Date: Jul.19, 2012 (54) MULTIMODAL VISIBLE POLYMER (30) Foreign Application Priority Data EMBOLIZATION MATERAL Jul. 7, 2009 (DE) ......................... 102O09.0321.89.6 (76) Inventors: Soenke Bartling, Heidelberg (DE); O O Shlomo Margel, Rehovot (IL); Publication Classification Hagit Aviv, Givart Shmuel (IL) (51) Int. Cl. A6IL 3L/04 (2006.01) (21) Appl. No.: 13/382,352 A6IL 3L/06 (2006.01) A6IL 3 L/18 (2006.01) (22) PCT Filed: Jul. 6, 2010 (52) U.S. Cl. ........................................................ 523/113 (57) ABSTRACT (86). PCT No.: PCT/EP2010/059631 The present invention relates to embolization material for S371 (c)(1), therapeutic use, wherein said material is visible via more than (2), (4) Date: Mar. 23, 2012 one imaging technique. Patent Application Publication Jul. 19, 2012 Sheet 1 of 19 US 2012/O184642 A1 8 3 x 8888: 83 x 38 : Patent Application Publication Jul. 19, 2012 Sheet 2 of 19 US 2012/O184642 A1 Patent Application Publication Jul. 19, 2012 Sheet 3 of 19 US 2012/O184642 A1 & S S S S S SS &S & S& SS S S & S S Patent Application Publication Jul. 19, 2012 Sheet 4 of 19 US 2012/O184642 A1 Patent Application Publication Jul. 19, 2012 Sheet 5 of 19 US 2012/O184642 A1 38 : x3.3 8:::::::::::::::: Patent Application Publication Jul.19, 2012 Sheet 6 of 19 US 2012/0184642 A1 Patent Application Publication Jul. 19, 2012 Sheet 7 of 19 US 2012/O184642 A1 Patent Application Publication Jul. 19, 2012 Sheet 8 of 19 US 2012/O184642 A1 Patent Application Publication Jul. 19, 2012 Sheet 9 of 19 US 2012/O184642 A1 Patent Application Publication Jul. 19, 2012 Sheet 10 of 19 US 2012/O184642 A1 SS S Patent Application Publication Jul.19, 2012 Sheet 11 of 19 US 2012/0184642 A1 Patent Application Publication Jul.19, 2012 Sheet 12 of 19 US 2012/0184642 A1 Patent Application Publication Jul. 19, 2012 Sheet 13 of 19 US 2012/O184642 A1 Patent Application Publication Jul. 19, 2012 Sheet 14 of 19 US 2012/O184642 A1 Patent Application Publication Jul. 19, 2012 Sheet 15 of 19 US 2012/O184642 A1 s: Patent Application Publication Jul. 19, 2012 Sheet 16 of 19 US 2012/O184642 A1 iiig. 8: Patent Application Publication Jul. 19, 2012 Sheet 17 of 19 US 2012/O184642 A1 3. Patent Application Publication Jul. 19, 2012 Sheet 18 of 19 US 2012/O184642 A1 Patent Application Publication Jul. 19, 2012 Sheet 19 of 19 US 2012/O184642 A1 US 2012/0184642 A1 Jul. 19, 2012 MULTIMODAL. VISIBLE POLYMER tional or plain radiography (X-ray based angiography), mag EMBOLIZATION MATERAL netic resonance angiography (MRA) based on magnetic reso nance imaging (MRI) and other radiography methods. Embolization is carried out either trans-arterial via micro 0001. The present invention relates to embolization mate catheter or via direct puncture, whereby the embolization rial for therapeutic use, wherein said material is visible via agent (e.g. occlusion emulsion) is injected via puncture more than one imaging technique. needle into the target region. DE 10261 694 describes injec 0002 Embolization therapy is a common therapeutical tion of a liquid embolization agent containing a protein emul concept to treat pathological alterations inside the human sion (Zein) and ethanol. body. Generally, vessels are blocked by an intravascular 0006 Common imaging techniques in radiology are application of a material. Various Substances can be intro angiography, X-ray computed tomography (CT), radiogra duced into the circulation (bloodstream) to occlude vessels, phy, magnetic resonance imaging (MRI), ultrasonography for example to arrest or prevent hemorrhaging, to devitalize a (US), nuclear medical techniques such as single photon emis structure, tumor, or organ by occluding its blood Supply; or to sion computed tomography (SPECT) and positron emission reduce blood flow to an arteriovenous malformation, or other tomography (PET), optical techniques, techniques enabling vascular malformation. For this purpose different materials localization via radio waves, and magnetic particle imaging have been tested which are termed embolization materials or technique. Embolization agents visible via radiology tech embolization agents synonymously in the following. niques enable their detection, localization, control of therapy 0003 Generally, embolization material or vascular embo by the aforementioned techniques, and their display whilst lization agents are particles (non-spherical or microspherical) application regarding the human body and pathological alter or fluids (glues, gels, Sclerosing agents and viscous emul ations. sions) that can be released into the bloodstream through a 0007 Currently, clinical embolization materials are not catheter or needle to mechanically and/or biologically visible by imaging techniques (Siskinet al., “Embolic Agents occlude the target vessels, either permanently or temporarily. Used for Uterine Fibroid Embolization', American Journal of Commonly, these materials are available as Solids, liquids or Roentgenology, 2000, 767-773). However, it is accepted that Suspensions. In principle, a selection of the embolization directly visible embolization material provides advantages agent based on the size and the calibre of the target vessels over non-visible embolization materials (Mottu et al., ensures that the occlusion is confined to the desired site. “Iodine-containing cellulose mixed esters as radiopaque Basically, particles cause mechanical occlusion, whereas polymers for direct embolization of cerebral aneurysms and glues and gelling Solutions solidify at the target, and e.g. arteriovenous malformations”, Biomaterials, 2002, 23, 121 acetic acid, ethanol, and various sclerosing agents modify the 131; Siskin et al., loc. cit.; Sharma et al., “Development of vessel wall and contents, leading to the development of a clot “imageable' beads for transcatheter embolotherapy”, JVasc that occludes the vessel (Loffroy et al., “Endovascular Thera Intery Radio, 2010, 21(6), 865-76). peutic Embolisation An Overview of Occluding Agents and 0008. An embolization material that is directly visible by their Effects on Embolised Tissues. Current Vasc Pharma animaging modality provides advantages to control the appli cology, 2009, 7, 1-14). cation of the embolization material, to verify and document 0004 Common treatment of vascular defects, e.g. intrac the therapy Success and might provide methods to detect ranial aneurysms, is performed using neuroSurgical clipping. misplacement of embolization material. A viable alternative for treatment of such conditions is endo 0009 Tumor embolization is currently mostly performed vascular embolization with platinum coils. High numbers of under X-ray control for application catheter placement, treat patients having a recurrence amenable to retreatment because ment planning as well as treatment control (Lubienski et al., of thrombus recanalization, aneurysm regrowth, or embolic “Update Chemoperfusion and -embolisation, Der Radio mass compaction led to development and clinical use of loge, 2007, vol. 47, 1097-106). embolic devices combining platinum coils with expandable 0010. It was proposed to switch to an MRI environment hydrogels or degradable polymers to reduce the retreatment for embolization therapy, because this would reduce or elimi rate. For example a dried hydrogel is placed over a platinum nate the necessary radiation dose, and would enable three coil, or degradable polymers such as copolymers of glycolic dimensional therapy control. As a consequence this would acid and lactic acid are placed over and/or inside a platinum widen the potential range of therapies and therefore increase coil. Besides, other materials, e.g. hydrogel filaments are the spectrum of potential patients. Especially young women currently used as implants for endovascular embolization with uterus fibroids could now undergo embolization treat Such as poly(ethylene), poly(ethylene glycol) diacrylate with ment without potential harm to the very radiation sensitive 2,4,6-triiodophenyl penta-4-enoate (PEG-I), poly(ethylene ovaries (Levy, “Modern management of uterine fibroids', glycol) diacrylamide with barium sulfate (PEG-B), poly(pro Acta ObstetGynecol Scand, 2008, 87(8), 812-23). pylene glycol) diacrylate with barium sulfate (PPG-B) (Con 0011 Various embolization materials exist being visible stant et al., “Preparation, Characterization, and Evaluation of via one radiology technique (X-ray computed tomography Radiopaque Hydrogel Filaments for Endovascular Emboliza (CT), radiography). There are also embolization materials tion”, J Biomedical Mat Research Part B. Appl Biomaterials, being visible via other imaging techniques, see for example 2008, 306–313). Nevertheless, currently available emboliza DE 10261694 (Zein-emulsion with radiocontrastagent); DE tion devices are either not visible (e.g. not radio-opaque, or 09414868 U1 (synthetic particle with Iodine), US 2005/ magnetic) by medical imaging techniques or visible only via 0.095428 (polymer with Ni Ti-alloy), and WO 2001/66016 CT but due to the metallic nature of platinum leading to (gas containing embolization agents). imaging artifacts. 0012. However, no embolization materials have been 0005 Embolization is frequently conducted under control described which are well visible in more than one imaging of medical imaging techniques including inter alia projec technique. Thus, there is currently a dependency on one imag US 2012/0184642 A1 Jul. 19, 2012 ing technique for controlling