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

Background and purposeThis study presents our initial experience using Obtura, 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 methodsFive 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.ResultsComplete obliteration was achieved in 100% of patients. The mean volume of Obtura used per transvenous session was 7.9 mL (range, 2-14 mL) ± 4.8. A combination of Obtura 15 and Obtura 12 was used in three cases, while Obtura 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).ConclusionsThe TVRPCT with extra-low viscosity Obtura 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 Obtura through the transvenous route were optimal, with no observed vascular rupture or extravasation.