Bradford resident Zehair Ayub has become the first patient in the UK to receive a new treatment for a life-threatening brain arteriovenous malformation (AVM), a condition that left him without options after 15 years of failed interventions.
Zehair underwent procedures at Leeds General Infirmary between September 2025 and May 2026, using a liquid embolic agent called ihtObtura. The treatment, not yet approved in the UK, was given on compassionate grounds as part of a European clinical trial.
Fifteen years of uncertainty
AVMs are rare, tangled clusters of blood vessels where arteries and veins connect abnormally, bypassing normal brain tissue. When they rupture, bleeding can be catastrophic or even fatal.
Zehair’s case was particularly difficult. His AVM, located deep in his brain, had formed a large aneurysm pressing on his optic nerves. Over time, his vision worsened, and he developed seizures and weakness on his right side. The risk of sudden hemorrhage remained constant.
Diagnosed in 2011, he first tried Gamma Knife radiosurgery in Sheffield, but the procedure failed to close the AVM. Other treatments followed, none successful. Traditional surgery was ruled out due to the AVM’s location. By the time he met Dr. Fathallah Islim, a consultant interventional neuroradiologist at Leeds, his options were nearly exhausted.
A treatment not yet available in the UK
ihtObtura works by injecting a liquid directly into the abnormal vessels, sealing them off. Unlike older materials, it gradually becomes invisible on scans, allowing doctors a clearer view of surrounding blood vessels for follow-up procedures.
The treatment required four sessions, with specialists from Germany and Spain assisting in Leeds. The collaboration was essential since ihtObtura wasn’t yet approved in the UK, and the team needed special permission to use it.
The outcome was immediate. Zehair’s AVM closed completely, and the aneurysm resolved. His neurological symptoms improved. For the first time in years, he could look ahead without constant fear.
“When I was diagnosed, I was fit and healthy,” he said. “I played football and cricket, went to the gym. Then everything changed overnight. I had a young family and my own business. I just wanted to return to normal.”
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For years, he lived with the knowledge that a bleed could happen at any moment. His vision deteriorated further, and his coordination declined. When doctors told him no more options existed, he felt trapped.
“Dr. Islim appeared at exactly the right time,” he said. “I knew it was a new treatment, but I trusted the team completely. Having experts from Leeds working with colleagues from Germany and Spain gave me confidence.”
A model for future care
Dr. Islim called the case a turning point. “Endovascular treatment of brain AVMs is often used only for untreatable cases. The risks are high, but ihtObtura cured Zehair’s AVM and restored his life. We hope for European and UK approval to help others.”
The success reflects broader changes in neurointerventional care. Advanced imaging, international expertise, and new materials are making once-inoperable conditions treatable. Leeds is becoming a center for complex AVM cases.
For Zehair, the change has been significant. He no longer waits for the next seizure or further vision loss. The AVM that dominated his life for over a decade is gone. The aneurysm that once threatened to rupture is resolved. He is still adjusting to a future without constant medical oversight.
“I just want to continue with my life,” he said. “I have my family and my business. I want to be myself again.”
The treatment’s long-term effects are still unknown. If approved, ihtObtura could provide hope to patients who, like Zehair, have no other options. His case shows that even the most complex AVMs can be treated with the right tools and team.
Leeds General Infirmary recently upgraded its imaging systems, including a new fluoroscopy system, which may further improve outcomes for patients like Zehair.
