Low-Profile High-Density Braid Occluder for Transcatheter Embolization of Pulmonary Arteriovenous Malformations

To determine the safety and efficacy of the low-profile braided occluder (LOBO; Okami Medical, San Diego, California) for embolization of pulmonary arteriovenous malformation.

Materials and Methods: A single center retrospective review included 18 PAVMs in 12 consecutive adult patients (10 female and 2 males; median age: 34.5 years, range: 20-68) treated with LOBO from January 2022 to June 2024. Sixteen PAVMs were simple architecture with one feeder pulmonary artery, whereas two were complex with multiple feeders. The median size of PAVMs was 8.5 mm (range: 5-22mm) with feeder artery diameter of 3 mm (range: 2-6 mm). Radiologic response was defined as lesion size decrease by >70%. To assess the time to deploy LOBO, the time stamp difference between pre- and post-embolization angiogram was calculated, and a control group of 14 consecutive, simple type and treatment-naïve PAVMs treated with coils-only were selected (treated from September 2014 to September 2022). The mean PAVM size (10.1 vs 10.3mm, p=0.905) and feeder artery diameter were comparable (3.1 vs 3.3mm, p=0.730) between the two groups.

Results:

A total of 22 occluders were deployed into the feeder pulmonary arteries (12 LOBO-3, 10 LOBO-5), achieving complete cessation of flow by end of procedures. No severe adverse events or device migrations occurred. There was no persistence or recanalization during imaging follow-up (median time from procedure to the most recent computed tomography: 6 months; range 1-48 months, available in 14 PAVMs). No catastrophic events occurred over a median clinical follow-up of 4 months (range 1.5-48 months, per patient, available in all 12 patients). Among the 14 simple type and treatment-naïve PAVMs treated with LOBO, the estimated time for deployment was shorter than their coil-only counterpart (mean: 6.5 min 13.9 min, p=0.0011). All embolization in the coil group required more than one coil.

Conclusion:

Using LOBO to treat PAVM was safe and effective. Compared to coils, LOBO embolization required fewer embolic and time to achieve flow stasis.