Transvenous curative embolization of brain arteriovenous malformations using extra-low viscosity iht Obtura versions: Initial experience and technical insights

Abstract

Background and purpose

This study presents our initial experience using _ihtObtura, a novel nonadhesive liquid embolic agent with extra-low viscosity variants, in transvenous curative embolization of brain arteriovenous malformations (bAVMs). We assess the agent's performance and compare its advantages with other extra-low viscosity options currently available.

Materials and methods

Five patients (three females, two males; mean age, 33 years; range, 20–55 years) with ruptured bAVMs were treated using the transvenous retrograde pressure cooker technique (TVRPCT). Three patients underwent staged embolization for large bAVMs, with the final session performed using TVRPCT, while two patients with smaller bAVMs were treated in a single session.

Results

Complete obliteration was achieved in 100% of patients. The mean volume of _ihtObtura used per transvenous session was 7.9 mL (range, 2–14 mL) ± 4.8. A combination of _ihtObtura 15 and _ihtObtura 12 was used in three cases, while _ihtObtura 15 alone was used in two cases. Complete angiographic occlusion was sustained at six and 24 months follow-up. Clinical outcomes improved in three patients and remained unchanged in two (mRS = 0).

Conclusions

The TVRPCT with extra-low viscosity _ihtObtura appears to be as safe and effective as other extra-low viscosity nonadhesive liquid embolic agents for curative treatment of bAVMs. The penetration, diffusion, and distribution of _ihtObtura through the transvenous route were optimal, with no observed vascular rupture or extravasation.