Clinical success and safety of N-butyl cyanoacrylate in emergency embolization: is operator experience a key factor?

N-butyl-cyanoacrylate (NBCA) is seen as a challenging embolization agent to use, requiring a learning curve. The study aims to evaluate the safety, efficacy and impact of operator's experience of NBCA as an embolic agent in emergency transarterial embolization (TAE).

All patients referred to University Hospital of Saint-Etienne who were treated by TAE with NBCA between January 1, 2016 and January 1, 2024 were retrospectively reviewed. The inclusion criteria were all patients ≥18 years old treated by TAE with NBCA. Demographic, biological and angiographic data were recorded. Clinical success was defined as resolution of signs and symptoms of bleeding during the 30-day follow-up period after TAE and without required endoscopic treatment, surgery, or repeat TAE or death of any cause. Predictive factors of early death (≤30 days) were assessed using univariate and multivariate analysis. Outcomes regarding operator's experience (more or less than 3 years in embolization) were reviewed.

During the study inclusion period, 113 patients (75, 66.4% males) for 113 procedures were included. The mean age was 64.1±14.1 years old. Clinical success was achieved in 93 (82.3%) patients. No major complication was recorded. There were 5 (4.4%) early rebleeding requiring 3 (2.7%) repeat TAE. Fifteen (13.3%) patients died within 30 days after the procedure. Operators with <3 years' experience had the same clinical outcomes as more experienced ones (P>0.05). In univariate analysis, hemodynamic instability, hemoglobin level <8 g/dL, and international normalized radio (INR) >1.5 were associated with early death. In multivariate analysis, hemodynamic instability was independently associated with early death [odds ratio (OR) =14.49; 95% confidence interval (CI): 2.33-282.1, P=0.01].

Use of NBCA demonstrates a low rebleeding rate, and safety profile of TAE using NBCA. Operators' experience has no significant impact on clinical outcomes.