Initial experience with precipitating hydrophobic injectable liquid in cerebral arteriovenous malformations

Abstract

Background: Precipitating hydrophobic injectable liquid is a newly introduced liquid embolic agent for endovascular embolization with some technical advantages over other liquid embolic agents. We present our initial experience with precipitating hydrophobic injectable liquid in the endovascular treatment of cerebral arteriovenous malformations.

Methods: From October 2015 to January 2018, 27 patients harboring cerebral arteriovenous malformations underwent endovascular embolization with precipitating hydrophobic injectable liquid 25. Clinical features, angiographic results, procedural details, complications, and follow-up details were retrospectively analyzed.

Results: Twenty-seven patients with cerebral arteriovenous malformations were included. Total obliteration in one endovascular session was confirmed for 14/27 (52%) patients. Partial embolization was attained in 13 patients (48%) in whom staged treatment with following radiosurgery or surgery was planned. No mortality was recorded in this series. Complications during or after the embolization occurred in six of 27 (22.2%) patients.

Conclusion: In our initial experience, precipitating hydrophobic injectable liquid has acceptable clinical outcome comparable to other liquid embolic agents. Although this is the largest reported study in arteriovenous malformation treatment with precipitating hydrophobic injectable liquid, further studies are needed to validate its safety and efficacy.

Keywords: Cerebral arteriovenous malformations (AVMs); embolization; liquid embolic agents (LEAs); precipitating hydrophobic injectable liquid (PHIL); unruptured brain AVMs.

Figure 1.

Patient with unruptured left frontal arteriovenous malformation (AVM). (a and b) Anteroposterior digital subtraction angiography shows the AVM fed by the left middle cerebral artery. (d and e) Selective contrast injections in the left internal carotid artery. (c and f) Apollo microcatheter injection of the middle cerebral artery afferent demonstrating embolization of the nidus with precipitating hydrophobic injectable liquid. Note that the tip of the microcatheter is clearly visible in the cast.

Figure 2.

(a and b) Frontal and lateral subtracted digital subtraction angiography injections showing the complete embolization of the left frontal unruptured arteriovenous malformation. (c and d) Native image demonstrating the opacities of the precipitating hydrophobic injectable liquid cast used for the embolization. (e) Axial non-contrast enhanced post-embolization computed tomography (CT) scan with minimal artifacts noted.

Figure 3.

(a and f) Left internal carotid and left vertebral artery (b and g) contrast injections demonstrating a left-sided unruptured occipito-parietal arteriovenous vascular malformation (AVM). Frontal (c and d) and lateral (h and i) views showing partial embolization of the AVM. Note the AVM remnant with reduced number of arterial feeders and changes in the venous drainage. (e and j) Precipitating hydrophobic injectable liquid.