Journal of Neuroradiology (2014) 41, 87—91
Available online at
ScienceDirect
www.sciencedirect.com
TECHNICAL NOTE
The Pressure Cooker Technique for the
treatment of brain AVMs
René Chapot
a,*
, Paul Stracke
a
, Aglaé Velasco
a
,
Hannes Nordmeyer
a
, Markus Heddier
a
, Michael Stauder
a
,
Petra Schooss
a
, Pascal J. Mosimann
a,b
a
Alfried-Krupp Krankenhaus Hospital, Department of Intracranial Endovascular Therapy, Alfried-Krupp
Strasse 21, 45131 Essen, Germany
b
Centre Hospitalier Universitaire Vaudois, University of Lausanne, Department of Radiology and
Neuroradiology, CH-1011, rue du Bugnon 46, Lausanne, Switzerland
KEYWORDS
Brain AVM;
Embolization;
Onyx;
Coils;
Glue;
Pressure cooker
Summary Arteriovenous malformations (AVMs) may be cured by injecting liquid embolic
agents such as Onyx. Reflux, however, can sometimes be difficult to control and may jeop-
ardize a complete embolization. The pressure cooker technique (PCT) was designed to create
an anti-reflux plug by trapping the detachable part of an Onyx-compatible microcatheter with
coils and glue in order to obtain wedge-flow conditions, thereby enabling a better understanding
of macrofistulous AVMs and a more comprehensive, forceful and controlled Onyx embolization.
The PCT might enlarge the range of AVMs amenable to endovascular cure. Three illustrative
cases are presented.
© 2013 Published by Elsevier Masson SAS.
Introduction
Brain arteriovenous malformations (AVMs) may be cured
with liquid embolic agents such as Onyx [1]. According to
the instructions for use, Onyx should be injected slowly
over several minutes to create a safe proximal plug and
Abbreviations: AVM, Arteriovenous Malformation; PCT, Pressure
Cooker Technique; IC, Internal Carotid Artery; DMSO, Dimethyl Sulf-
oxide; NBCA, n-butyl cyanoacrylate.
Portions of this work were presented as an abstract and oral
presentation at the ABCWIN Seminar in Val d’Isère, France, January
17th, 2013.
∗
Corresponding author. Tel.: +49 201 434 2556;
fax: +49 201 434 2375.
E-mail address: rene.chapot@krupp-krankenhaus.de
(R. Chapot).
minimize backflow. Multiple cycles of short-lived injections
interspaced by several waiting periods are often required
which may disrupt the progression of Onyx through the
nidus, thereby forcing one to prematurely abort the proce-
dure. We describe a new method to avoid reflux and enable
a more comprehensive, forceful and continuous injection
of Onyx that we have called the pressure cooker technique
(PCT).
Technique
The PCT consists of creating a plug of coils and glue between
the tip and the detachment zone of a previously placed
DMSO-compatible microcatheter (Sonic, Balt Extrusion,
Montmorency, France) [4] to enable a continuous injection
of Onyx (Ev3-Covidien, Dublin, Ireland) while avoiding
reflux at the same time. To create the plug, a second
0150-9861/$ – see front matter © 2013 Published by Elsevier Masson SAS.
http://dx.doi.org/10.1016/j.neurad.2013.10.001