Mechanical optimization of an arteriovenous malformation embolization material: a predictive model analysis.

Arteriovenous malformations (AVMs) pose a constant danger of hemorrhages, seizures, and headaches to patients; they also disrupt oxygen-rich blood flow entering capillaries of the brain. We have utilized a linear model to mechanically characterize and optimize a water-borne, reverse emulsion, self-reactive, in situ cross-linking material, which we propose clinical use as an embolization material. The material is formed by cross-linking various acrylate and thiol multifunctional precursors with NaOH supplemented PBS. We compared theoretical elastic modulus values to modulus values observed during compression testing to determine the cross-linking efficiency of the material. Empirically determined elastic moduli for various material compositions ranged from 0.76 to 2.26 MPa, with corresponding cross-link efficiencies averaging 55+/-4%. We predict a reduction in theoretical circumferential stress exerted on AVM vasculature from 4933 to 10.9 Pa after embolization with the optimal material configuration. Theoretical risk of AVM rupture, as defined by Hademenos et al., was reduced below 1.0% for extreme variations of vessel modulus, thickness, and blood pressure after embolization with the optimized material. We will be using this material configuration to embolize swine rete mirabile AVM models and further assess the clinical viability of this potential embolization material.