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

Background: 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). Methods: 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. Results: 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]. Conclusions: Use of NBCA demonstrates a low rebleeding rate, and safety profile of TAE using NBCA. Operators' experience has no significant impact on clinical outcomes.