N-hexyl cyanoacrylate (NHCA) is a fast-polymerizing liquid embolic agent used in endovascular procedures to occlude blood vessels in the treatment of vascular malformations, such as arteriovenous malformations (AVMs) and dural arteriovenous fistulas (dAVFs).

NHCA is a long-chain alkyl derivative of cyanoacrylate, composed of monomers that rapidly polymerize upon contact with ionic fluids (e.g., blood or saline), forming a solid cast within the vessel.

NHCA is part of the cyanoacrylate family of adhesives, differing from shorter-chain compounds (e.g., n-butyl cyanoacrylate, NBCA) by its:

• Slower polymerization speed
• Greater flexibility and control during injection
• Improved radiopacity when mixed with Lipiodol

Cyanoacrylates are fast-polymerizing liquid embolic agents used in endovascular procedures. The two most used types in neurointervention are:

• NBCA = N-butyl cyanoacrylate
• NHCA = N-hexyl cyanoacrylate

• NBCA: Shorter alkyl chain (4 carbon atoms)
• NHCA: Longer alkyl chain (6 carbon atoms)

→ Longer chains polymerize more slowly, allowing greater control.

• NBCA: Very fast polymerization → hard to control
• NHCA: Slower polymerization → more time to reach the nidus

→ NHCA is more forgiving during injection.

• NBCA: Higher risk of catheter entrapment, requires rapid and decisive injection
• NHCA: Easier manipulation, more predictable penetration, especially when diluted 1:4 with Lipiodol

• NBCA: Often used for proximal feeder embolization or high-flow AVMs
• NHCA: Better suited for deep intranidal penetration due to slower flow and better control

• NBCA: Higher risk due to abrupt polymerization
• NHCA: Lower risk with proper dilution and technique

• NBCA: Widely available, inexpensive
• NHCA: Slightly higher cost, less widely available

• Both are typically diluted with Lipiodol to modulate polymerization and increase radiopacity

• Both are permanent, non-resorbable, and carry risk of embolizing healthy tissue
• Require experienced operators
• Neither offers the plug-and-push properties of agents like Onyx or PHIL

• Murias Quintana E, et al. *Use of NHCA…* Cureus. 2025;17(5):e84290.
• Chapot R, et al. *Neurointerventional embolic agents: a technical and practical overview.*

NHCA is used as a liquid embolic agent in:

• Intranidal AVM embolization
• Preoperative devascularization
• Arterial feeder occlusion
• Treatment of superficial vascular malformations
• Selected dAVFs

• Commonly diluted with Lipiodol (usually 1:3 to 1:4 ratio) to modulate viscosity and radiopacity.
• Requires coaxial microcatheter systems and precise control to avoid non-target embolization.
• Compatible with DMSO-free catheters, unlike Onyx or PHIL.

• Deep intranidal penetration possible
• Fast solidification on contact with blood
• No need for DMSO-compatible devices
• Lower cost compared to Onyx

• Risk of catheter entrapment if not withdrawn promptly
• Permanent and non-resorbable
• Potential for non-target embolization
• Rapid polymerization can be difficult to control in tortuous anatomy
• No long-term outcome data for some formulations (e.g., NHCA vs. NBCA)

• NBCA (n-butyl cyanoacrylate)
• Onyx (ethylene-vinyl alcohol copolymer)
• PHIL (precipitating hydrophobic injectable liquid)
• Squid (EVOH-based)

In a retrospective single-center case series (n=22 patients, 24 procedures) with no control group or comparison, Murias Quintana et al. from the Hospital Universitario Central de Asturias, Oviedo, Hospital Clínic de Barcelona, Hospital Universitario Marqués de Valdecilla, Santander, Alfried Krupp Krankenhaus, Essen, Hospital Universitario de Salamanca ¹⁾ aim to describe outcomes after the use of N-hexyl cyanoacrylate (NHCA, “Magic Glue”) for AVM embolization. Despite its stated aim of evaluating “strengths and limitations,” the article offers a one-sided, promotional narrative that lacks critical analysis.

The journal *Cureus* is increasingly known for:

• Minimal peer review
• Inflated author lists
• A tendency to prioritize upload speed over scientific rigor

This paper reinforces that reputation, providing more of a procedural diary than a peer-reviewed study. It embodies editorial complacency and academic dilution.

A retrospective case series offers no comparative insight. There is:

• No randomization
• No control group
• Noprospective outcome measures

This is not hypothesis-testing research — it’s purely observational, anecdotal reporting.

The paper defines technical success as “the outcome achieved based on objective.” This is circular reasoning and renders the concept of success meaningless.

Injection times and catheter models are listed with obsessive detail:

• HeadWay Duo 167 cm in 70.8%
• Magic 1.2F in the rest
• Injection times: 27 seconds to 9 minutes 38 seconds

Yet none of these details translate to improved patient care or clinical insight.

No adverse events in 24 procedures cannot be extrapolated as “safe.” This cohort is underpowered to detect rare but serious complications — a classic false sense of security.

Only '3 out of 24 cases (12.5%)' achieved complete occlusion with a single NHCA injection. The authors still call it “effective.” This is an example of:

• ::unjustified enthusiasm::
• ::intellectual dishonesty::

Frequent use of the term “Magic Glue” and positive adjectives for NHCA give this paper the tone of a product brochure, not a neutral scientific analysis.

Key omissions include:

• No clinical or imaging follow-up data
• No outcome measures beyond technical success
• No comparison with other embolic agents (Onyx, PHIL, Squid)
• No cost-benefit analysis
• No discussion of failure cases or limitations in complex AVMs

This paper does not meet the standards of a rigorous scientific study. It provides:

• No high-quality evidence
• No clinically useful guidance
• No long-term data

It reinforces the perception of *Cureus* as a platform for uploading technically correct but scientifically irrelevant work. A procedural note disguised as research, this article is a missed opportunity to meaningfully contribute to the field of neurointerventional radiology.

Final Verdict: This is not a “study” — it is a technical anecdote polished with promotional language and framed in a journal that too often rewards upload volume over scientific substance.