Coil-assisted n-butyl-2-cyanoacrylate embolization for treatment of pulmonary arteriovenous malformation: an initial clinical experience.

PURPOSE: To investigate the safety and efficacy of coil-assisted n-butyl-2-cyanoacrylate (NBCA) embolization in patients with pulmonary arteriovenous malformation (PAVM). MATERIALS AND METHODS: From February 2023 to December 2025, this retrospective study included previously untreated patients with PAVM who underwent coil-assisted NBCA embolization involving detachable microcoil placement in the draining vein followed by NBCA embolization of the sac and feeding artery. This technique was developed to address limitations of prior balloon-occluded NBCA embolization technique. RESULTS: Twenty-nine patients (mean age, 50.3 years ± 11.6; 27 women) with 34 sporadic PAVMs (simple type, n=33; complex type, n=1) were analyzed. Technical success rate was 100% (34/34; 95% confidence interval: 89.7%-100%). The microcoil was successfully positioned in either the draining vein (n=31) or the distal sac (n=3), facilitating controlled delivery of the NBCA mixture. Complete sac embolization was achieved using NBCA alone in all 34 PAVMs. Complete feeding artery embolization was achieved with NBCA alone in 32 PAVMs, whereas feeding artery occlusion required additional vascular plug placement in two. A total of 52 detachable microcoils were used in 34 PAVMs (mean, 1.5 per PAVM). A fixed 1:2 NBCA/iodized oil ratio was used and the mean amount of NBCA mixture per PAVM was 1.4 mL (range, 0.5-2.4 mL). No procedure-related major adverse events occurred. Transient minor pleuritic chest pain occurred in five patients (17.2%). Follow-up computed tomography in 29 patients with a mean delay of 11.3 ± 5.7 months (range, 3.4- 24 months) demonstrated complete occlusion without evidence of reperfusion during follow-up. CONCLUSION: Coil-assisted NBCA embolization may be technically feasible and effective for patients with PAVM, with complete occlusion during short-term follow-up while mitigating the risk of embolic migration.