Objectives: To identify the most suitable size of imaging-visible embolic agents with balanced safety and efficacy for bariatric arterial embolization (BAE) in a preclinical model.Materials and methods: Twenty-seven pigs were divided into 3 cohorts. In Cohort I, 16 pigs were randomized to receive (n = 4 each) 40-100-mu m microspheres in 1 or 2 fundal arteries, 70-340-mu m radiopaque microspheres in 2 fundal arteries, or saline. In Cohort II, 3 pigs underwent renal arterial embolization with either custom-made 100-200-mu m, 200-250-mu m, 200-300-mu m, or 300-400-mu m radiopaque microspheres or Bead Block 300-500 mu m with microsphere distribution assessed histologically. In Cohort III, 8 pigs underwent BAE in 2 fundal arteries with tailored 100-200-mu m radiopaque microspheres (n = 5) or saline (n = 3).Results: In Cohort I, no significant differences in weight or ghrelin expression were observed between BAE and control animals. Moderate-to-severe gastric ulcerations were noted in all BAE animals. In Cohort II, renal embolization with 100-200-mu m microspheres occluded vessels with a mean diameter of 139 mu m +/- 31, which is within the lower range of actual diameters of Bead Block 300-500 mu m. In Cohort III, BAE with 100-200-mu m microspheres resulted in significantly lower weight gain (42.3% +/- 5.7% vs 51.6% +/- 2.9% at 8 weeks; P = .04), fundal ghrelin cell density (16.1 +/- 6.7 vs 23.6 +/- 12.6; P = .045), and plasma ghrelin levels (1,709 pg/mL +/- 172 vs 4,343 pg/mL +/- 1,555; P < .01) compared with controls and superficial gastric ulcers (5/5).Conclusions: In this preclinical model, tailored 100-200-mu m microspheres were shown to be most suitable for BAE in terms of safety and efficacy.
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