GLUBRAN 2 Chemical and Physical characteristics, Polymerization Profile and Possible Interactions
Francesco Gini MD
Welcome everybody, today I am going to give you some basic information about cyanoacrylates in relation to Glubran®2. Cyanoacrylates are liquid adhesive embolic agents, that allow for permanent occlusion. Some of their characteristics include: liquid state low viscosity, high polymerization rates, and bacteriostatic activity. They are not radiopaque and they need to be mixed with iodized oils, such as Lipiodol. Blood vessels that are subjected to cyanoacrylates injection are embolized via three mechanisms: (1) cast and thrombus formation, (2) the adhesion to the inner vascular wall, and (3) damage to the vascular endothelium caused by an inflammatory response.
Currently available options include:
– pure NBCA (N-butyl 2 cyanoacrylate), with no CE mark for intravascular use;
– Glubran®2, which is a modified type of cyanoacrylate (N-butyl 2 cyanoacrylate + methacryloxy sulfolane), with CE mark for intravascular use;
– NHCA (N-hexyl 2 cyanoacrylate), with CE mark for intravascular use (only few indications).
Compared to pure NBCA, Glubran®2 presents a lower polymerization temperature (max 45° C), a slower polymerization rate, and a milder inflammatory reaction. It is also pliable and therefore more elastic. It is a Class III surgical medical device, widely used in surgery and certified with a CE mark for internal and endovascular use. The packaging includes 10x1ml vials, contained in foil blisters. Physical-chemical characteristics: it appears clear and transparent, with a typical cyanoacrylate smell and water-like density. The polymerization process starts when the product comes into contact with wet environments, such as blood, tissues, or any other bodily fluid. When injected in a vein or an artery, it solidifies within seconds, resulting in a stable and permanent occlusion of the vessel, with no recanalization. The mixture with Lipiodol, while increasing viscosity, allows for improved visualization and delays polymerization time. When mixing the products, we need to avoid contact with ionic solutions, such as blood and saline, and use a glucose solution instead (5%-33%). It is important to underline that we talk about tailored dilution, as this practice cannot be standardized and varies according to the specific case. Detailed information about Glubran®2 in Interventional Radiology is available in our new brochure.