A man from Bradford has become the first patient in the UK to receive a groundbreaking new treatment for a disabling and life-threatening arteriovenous malformation (AVM), after exhausting every other treatment option over 15 years.
An AVM is an abnormal tangle of connections between blood vessels, where arteries and veins connect directly rather than through the usual network of capillaries. This disrupts normal blood circulation and leaves the affected vessels prone to rupturing, which can cause life-threatening bleeding.
In the case of Zehair Ayub, the patient, his AVM was located deep in his brain and had developed a large aneurysm that was pressing on his visual nerves, causing some loss of sight and leaving him at high risk of a potentially fatal or life-changing brain haemorrhage.
Zehair was first diagnosed with the condition in 2011. He underwent Gamma Knife radiosurgery in Sheffield, which proved ineffective, and explored other treatment options over the following years, but none offered a good chance of success.
Because of the AVM’s location deep in his brain, conventional surgery was considered too risky. He continued living with the condition as his symptoms worsened, experiencing seizures, right-sided weakness and deteriorating vision, all the while aware that a major bleed could happen at any time.
Zehair was offered fresh hope after meeting Dr Fathallah Islim, a consultant interventional neuroradiologist at Leeds Teaching Hospitals NHS Trust, who had completed a fellowship at a centre in Germany involved in the European trial of an innovative new treatment called ihtObtura.
Because the trial was not taking place in the UK, Dr Islim secured special approval for Zehair to receive the treatment on compassionate grounds.
ihtObtura is a novel liquid embolic agent, injected directly into the affected blood vessels to close them off and stop blood flowing abnormally through the AVM. Unlike other embolic agents used in this kind of treatment, it is no longer visible on scans after a short period of time, which allows doctors to see the blood vessels clearly and guide further treatment accurately.
That makes it possible to carry out safe, staged treatment of large brain AVMs that would historically have been considered untreatable.
With support from international trial experts who travelled to Leeds General Infirmary, Zehair underwent four rounds of treatment between September 2025 and May 2026.
His AVM is now fully closed, the aneurysm has gone, and his physical symptoms have significantly improved.
Zehair Ayub said: “When I was diagnosed, I was fit and healthy. I played football and cricket, went to the gym and was always active. Then almost overnight, everything changed.” He said he had never heard of an AVM before being told he had the rare condition and that it could cause a catastrophic bleed; with a young family and his own business, he said, all he wanted was to get back to normal and carry on with his life.
“For 15 years I lived with the AVM, but I was eventually told there were no treatment options left. Everything was getting worse so quickly,” Zehair said. His eyesight was failing and his coordination going, he said, and he knew he needed help — Dr Islim, he said, came along at exactly the right time.
“I knew I was taking a chance on a new treatment, but I had complete confidence in the team. Having experts from Leeds working alongside colleagues from Germany and Spain gave me real reassurance that I was in the best possible hands,” Zehair said.
Risks are high and daunting
Dr Islim said: “Endovascular treatment of brain AVMs is often reserved for untreatable AVMs. The risks are high and daunting for both the clinician and patient.” He said ihtObtura had helped cure Zehair’s AVM and get his life back, which he and the team were delighted about, and that they were eager to secure European and UK approval for the treatment to help other patients in future.
Zehair added: “I’m incredibly grateful to everyone involved. Dr Fathallah and the whole team gave me hope when I thought I’d run out of options. Thanks to this treatment, not only has my own life changed, but I know other patients will benefit from it in the future too.”
