Injection of N‑butyl Cyanoacrylate Through a Dual-Lumen Balloon for Embolization of High-flow Intranidal Fistulas in Brain Arteriovenous Malformations: Technical Note

  • Eimad ShotarEmail author
  • Amira Al Raaisi
  • Stephanie Lenck
  • Kevin Premat
  • Vincent Degos
  • Bertrand Mathon
  • Frédéric Clarençon
  • Nader-Antoine Sourour
Original Article



N-butyl cyanoacrylate (NBCA) glue is a valuable liquid embolic agent for the endovascular treatment of brain arteriovenous malformations (BAVM). The use of NBCA carries a risk of embolic agent reflux and distal migration with ensuing possibility of venous drainage compromise. The aim of this technical note is to describe a single center case series of high-flow intranidal fistulas embolized though a dual lumen balloon under local flow-arrest conditions.


This article presents a retrospective description of a case series including five NBCA injections through a dual lumen balloon performed by a single operator in three patients with BAVM. Demographic, clinical, imaging and procedure-related data are reported.


The three patients presented with ruptured BAVMs. Of the patients, one underwent proximal flow-related ruptured aneurysm coiling before planned BAVM embolization. In the three patients, staged BAVM embolization as a first line treatment was decided. Preliminary embolization of high-flow BAVM fistulas by NBCA using a dual lumen balloon under local flow-arrest conditions was performed and five separate injections were carried out without any complications. No balloon entrapment or rupture was observed.


High-flow BAVM fistulas can be treated with NBCA embolization using a dual lumen balloon under local flow-arrest conditions.


Arteriovenous malformation Dual lumen balloon Embolization Fistula N-butyl cyanoacrylate 



This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Author Contribution

Conception or design of the work: E. Shotar, F. Clarençon, N.‑A. Sourour; data acquisition: E. Shotar, A. Al Raaisi, N.‑A. Sourour; data analysis: E. Shotar, A. Al Raaisi, F. Clarençon, N.‑A. Sourour; drafting the work: E. Shotar, A. Al Raaisi, F. Clarençon, N.‑A. Sourour; critical revision of the work for important intellectual content: all co-authors; final approval of the version to be published: all co-authors; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all co-authors.

Conflict of interest

F. Clarençon: consultant for Truffle Capital, Penumbra, Guerbet and Stryker. N.‑A. Sourour: consultant for Balt. E. Shotar, A. Al Raaisi, S. Lenck, K. Premat, V. Degos and B. Mathon declare that they have no competing interests.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Sorbonne UniversitéParisFrance
  2. 2.Department of NeuroradiologyPitié-Salpêtrière HospitalParisFrance
  3. 3.Department of Neurosurgical Anesthesiology and Critical CarePitié-Salpêtrière HospitalParisFrance
  4. 4.Department of NeurosurgeryPitié-Salpêtrière HospitalParisFrance

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