Imipenem/Cilastatin in Embolization: From Antibiotic to Therapeutic Agent

Imipenem (IPM) is a broad-spectrum β-lactam antibiotic primarily used to treat bacterial infections. Beyond its antimicrobial properties, it has also been explored as a temporary embolic agent in interventional radiology. This application is due to its ability to form particulate suspensions, leading to transient occlusion of small blood vessels.

As an embolic agent, imipenem cilastatin (IPM/CS) induces vessel occlusion and typically recanalizes within 90 min to 48 h in normal vasculature, though recanalization may take longer in inflamed or hyperemic tissues. As cilastatin may exhibit anti-inflammatory effects, potentially enhancing the therapeutic profile of the compound, this property makes it particularly useful for conditions associated with abnormal neovascularization and inflammation. IPM/CS has been commonly used for temporary embolization in the treatment of musculoskeletal conditions, tumor-related bleeding, and inflammatory hyperemia, and offers a minimally invasive therapeutic approach with rapid resolution.

Clinical studies have demonstrated its safety, with minimal complications compared to permanent embolic agents. Unlike permanent embolization materials, its transient nature reduces the risk of long-term ischemic damage while effectively managing pain and inflammation. Given its dual function as both an antibiotic and an embolic agent, IPM/CS represents a promising tool in interventional radiology, warranting further research to optimize its clinical applications. The aim of this review is to summarize the current evidence on the clinical applications, mechanisms, and outcomes of IPM/CS as a temporary embolic agent, and to highlight future directions for its use in interventional radiology.