Use of N-hexyl Cyanoacrylate Monomers for the Treatment of Intra- and Extracranial Arteriovenous Malformations: A Single-Center Experience

TL;DR

This study explores the safe and effective use of a type of medical glue called N-hexyl cyanoacrylate in treating complex brain and head vascular malformations.

Contribution

The paper presents a novel clinical application of N-hexyl cyanoacrylate in treating complex vascular malformations with high technical success and no major complications.

Findings

N-hexyl cyanoacrylate was successfully used in 87.5% of cases with a 1:4 dilution ratio in lipiodol.

No clinically significant complications occurred during the procedures.

The embolic agent demonstrated optimal penetration and advancement in complex vascular structures.

Abstract

Purpose: Liquid embolic agents (LEAs) are commonly used in the endovascular treatment of vascular malformations for their penetration, visibility, and reflux control. This study presents our experience with N-hexyl cyanoacrylate (NHCA), also known as "Magic Glue," and its strengths and limitations.
Methods: A retrospective single-center case series study was conducted to assess outcomes among patients with complex head and neck vascular lesions treated with NHCA injection at Hospital Universitario Central de Asturias, Oviedo, Spain, between January 2022 and December 2023. Procedure and outcome measures included justification for using NHCA, technical success (defined as the outcome achieved based on objective), materials used for catheterization, dilution ratio of NHCA, and observations of technical significance during the procedure.

Results: A total of 24 NHCA injections were performed in 22 patients with intra- and extracranial vascular lesions. An arteriovenous malformation (AVM) was treated in 83.3% (20/24) of cases, including nidal pseudoaneurysms in ruptured AVMs (8/24, 33.3%), arterial feeder embolization in AVM treatment (7/24, 29.2%), and single-feeder AVMs (5/24, 20.8%). The remaining cases included bone or skin vascular malformations (2/24, 8.3%) and dural arteriovenous fistulas (2/24, 8.3%). In 87.5% (21/24) of cases, procedures were successful using a 1:4 dilution ratio of NHCA in lipiodol. In 70.8% (17/24) of cases, the HeadWay Duo 167 cm microcatheter was used to gain arterial access, and the Magic 1.2F 165 cm microcatheter was used in the remaining cases. Injection durations ranged from 27 seconds to 9 minutes and 38 seconds. No clinically significant complications occurred, and microcatheter retrieval was successful in 100% of cases. Complete occlusion with a single NHCA injection into the arterial feeder was achieved in 12.5% (3/24) of cases. NHCA demonstrated optimal penetration and advancement capacity in both intranidal and proximal injections, allowing effective embolization of complex vascular structures.
Conclusion: NHCA demonstrated safe and effective penetration and advancement in both intranidal and proximal injections, allowing successful embolization of complex vascular structures. Further research is necessary to establish its long-term efficacy and optimize its clinical applications.

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