Embolisation of dural arteriovenous fistula with novel embolic agent EasyX

Abstract Background Dural arteriovenous fistulas (dAVF) are abnormal connections between dural arteries and intracranial veins or dural sinuses. Endovascular management for fistula closure has been recommended as first line treatment for dAVF. Various embolizing agents like glue, onyx are used for embolisation of dAVF. We describe a case of isolated superior sagittal sinus dAVF embolised using novel liquid embolising agent, EasyX. EasyX is a new non-adhesive liquid embolic agent based on polyvinyl alcohol ether polymer labeled with iodine molecules. The role of EasyX for peripheral embolisation have been studied. However, to the best of our knowledge, no studies have been published regarding use of EasyX in embolisation of dAVF. We describe a case of 35 year old male who presented with altered sensorium and diagnosed with isolated superior sagittal sinus dAVF. Embolisation of dAVF was done using EasyX successfully and patient’s clinical condition improved. Case presentation 35 year old male patient presented with altered sensorium since 3 days with gradual decrease in GCS. CECT head revealed acute bleed in right parieto-occipital lobe and multiple tortuous vascular channels in cisternal spaces and along cerebral convexities. 6 V DSA was performed which revealed isolated superior sagittal sinus dural arteriovenous fistula with feeders from bilateral middle meningeal arteries, posterior meningeal branch of right vertebral artery and dural branches of left ophthalmic artery. GCS before embolisation was E2V1M4. Right middle meningeal artery was accessed through microcatheter and traversed distally to reach fistulous point and embolised using EasyX. Post embolisation DSA revealed complete exclusion of dAVF. Post embolisation, patient’s GCS improved with GCS of E4V5M6 within 24 h. Conclusion EasyX is a novel non-adhesive liquid embolic agent described for peripheral embolisation. EasyX can be safely used in treating dAVF with advantages being absence of streak artefacts on CT due to absence of tantalum and easy withdrawal of microcatheter and lesser chances of catheter tip detachment due to non-adhesive nature.