LIQUID - Treatment of high-grade dural arteriovenous fistulas with Squid liquid embolic agent: a prospective, observational multicenter study.

Background: Endovascular embolization is a feasible treatment for cranial dural arteriovenous fistulas (DAVFs). New embolic agents aim to improve the success of DAVF embolization.
Objective: To assess the safety, efficacy, and short-term outcome of the treatment of DAVFs using the new liquid embolic agent Squid.
Methods: The LIQUID study is a prospective, observational multicenter study on the treatment of high-grade (Cognard type ≥3) DAVFs with the embolic agent Squid. The primary outcome measures were safety (ie, morbidity and mortality), as well as the occlusion rate 90 to 180 days after treatment.
Results: In eight centers, 53 patients (mean age 59.8 years, 22.6% female) were treated in 55 treatment sessions. Of the DAVFs, 56.6% were Cognard type III, 41.5% type IV, and 18.9% were ruptured. Squid 18 was used in 83.6% and Squid 12 in 32.7% of the treatments. The overall rate of intraprocedural or postprocedural adverse events (AEs) was 18.2%. Procedure-related AEs resulting in permanent morbidity were observed in 3.6%. One patient (1.8%) died unrelated to the procedure due to pulmonary embolism. The final complete occlusion rate at 90 to 180 days was 93.2%. After a mean follow-up of 5.5 months, the modified Rankin Scale (mRS) score was stable or improved in 93.0%. In one of the patients, worsening of the mRS score was related to the procedure (1.8%).
Conclusion: Squid is a safe and effective liquid embolic agent for the treatment of high-grade DAVFs.
Competing Interests: Competing interests: DFV reports consultancy for Medtronic and payed lectures for Cerenovus, and a research grant by MicroVention (unrelated to this work). TB reports payment for lectures and presentations from Stryker, Penumbra, and support for attending meeting and/or travel from Phenox, Microvention, and Stryker in the last 3 years. ABe reports proctoring for Microvention, Stryker, and Medtronic; payments for lectures for Stryker, Phenox and Penumbra; and board fees for CEC (Phenox) and Bayer. SM reports consultancy for Stryker, Medtronic, Acandis GmbH, Novartis Pharma GmbH (unrelated to study) and a travel grant by Balt (unrelated to study). TL has proctored and consulted for CERUS, Stryker, Phenox, Acandis, Medtronic, Pfizer and Microvention within the past three years but has no direct conflict of interest in the realm of this study. MB reports the following conflicts of interest outside the present work: board membership: DSMB Vascular Dynamics; consultancy: Roche, Guerbet, Codman; grants/grants pending: DFG, Hopp Foundation, Novartis, Siemens, Guerbet, Stryker, Covidien; payment for lectures (including service on speakers bureaus): Novartis, Roche, Guerbet, Teva, Bayer, Codman. MAM has received consulting honoraria, speaker honoraria, and travel support outside this work from Codman, Covidien/Medtronic, MicroVention, Phenox, and Stryker. The other authors declared no specific conflict of interest.
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