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PT  - JOURNAL ARTICLE
AU  - Clarençon, F.
AU  - Stracke, C.P.
AU  - Shotar, E.
AU  - Wallocha, M.
AU  - Mosimann, P.J.
AU  - Boch, A.-L.
AU  - Sourour, N.
AU  - Chapot, R.
TI  - Pressure Cooker Technique for Endovascular Treatment of Spinal Arteriovenous Fistulas: Experience in 15 Cases
AID  - 10.3174/ajnr.A7078
DP  - 2021 Jul 01
TA  - American Journal of Neuroradiology
PG  - 1270--1275
VI  - 42
IP  - 7
4099  - http://www.ajnr.org/content/42/7/1270.short
4100  - http://www.ajnr.org/content/42/7/1270.full
SO  - Am. J. Neuroradiol.2021 Jul 01; 42
AB  - BACKGROUND AND PURPOSE: Spinal arteriovenous fistulas are challenging to cure by endovascular means, with a risk of incomplete occlusion or delayed recurrence. The authors report herein their preliminary experience using the pressure cooker technique for the embolization of spinal arteriovenous fistulas.MATERIALS AND METHODS: Fifteen patients (8 men; mean age, 60.3 years) underwent an endovascular treatment of a spinal arteriovenous fistula (12 dural spinal arteriovenous fistulas and 3 epidural spinal arteriovenous fistulas) in 2 different institutions using the pressure cooker technique. Two microcatheters could be navigated in the segmental artery in all patients using 2 guiding catheters. A proximal plug was achieved with highly concentrated cyanoacrylate ± coils. The liquid embolic agent injected to cure the fistula was diluted cyanoacrylate (n = 11) or ethylene-vinyl alcohol (n = 4). Technical and clinical complications were systematically recorded. Clinical and angiographic outcomes were systematically evaluated at follow-up.RESULTS: One (6.7%) procedure-related complication was recorded, which consisted of a transient radicular deficit, related to nerve root ischemia. Clinical improvement was observed in 10/14 (71%) patients for whom clinical follow-up was available. Complete spinal arteriovenous fistula occlusion on a follow-up angiography was observed in 11/12 patients (91.7%) for whom angiographic follow-up was available. One patient (8.3%) presented with a delayed recurrence at 29 months.CONCLUSIONS: The pressure cooker technique is feasible, with either glue or ethylene-vinyl alcohol, for the embolization of spinal arteriovenous fistulas. Our results suggest the safety and effectiveness of this technique.EVOHethylene-vinyl alcoholIQRinterquartile rangePCTpressure cooker techniqueSAVFspinal arteriovenous fistula