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Original research
The transvenous retrograde pressure cooker technique for the curative embolization of high-grade brain arteriovenous malformations
  1. Masaomi Koyanagi,
  2. Pascal John Mosimann,
  3. Hannes Nordmeyer,
  4. Markus Heddier,
  5. Juergen Krause,
  6. Ana-Paula Narata,
  7. Ahmed El Serwi,
  8. Christian Paul Stracke,
  9. René Chapot
  1. Department of Neuroradiology and Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus Rüttenscheid, Essen, Germany
  1. Correspondence to Dr Masaomi Koyanagi, Neuroradiology and Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus Rüttenscheid, Essen 45131, Germany; koyanagm{at}gmail.com

Abstract

Background Transvenous embolization of brain arteriovenous malformations (AVMs) can be curative. We aimed to evaluate the cure rate and safety of the transvenous retrograde pressure cooker technique (RPCT) using coils and n-butyl-2-cyanoacrylate as a venous plug.

Methods All AVM patients treated via transvenous embolization between December 2004 and February 2017 in a single center were extracted from our database. Inclusion criteria were: inability to achieve transarterial cure alone; AVM < 3 cm; and single main draining vein. Outcome measures were immediate and 90 days' angiographic AVM occlusion rate, and morbidity and mortality at 30 days and 12 months, according to the modified Rankin Scale (mRS) score.

Results Fifty-one patients (20 women; median age 47 years) were included. A majority (71%) were high grade (3 to 5 in the Spetzler–Martin classification). AVMs were deeply seated in 30 (59%) and cortical in 21 patients (41%). Thirty-three patients were previously embolized transarterially (65%). All patients but one were cured within a single session with the RPCT (96%). Cure was confirmed on follow-up digital subtraction angiography at 3 months in 82% of patients. Three patients experienced intracranial hemorrhage (6%), one requiring surgical evacuation. There were no deaths. One treatment-related major permanent deficit was observed (2.0%). Mean mRS before treatment, at 30 days, and 12 months after RPCT was 1.5, 1.5, and 1.3, respectively.

Conclusions The retrograde pressure cooker technique can be curative in carefully selected high-grade AVMs. Long-term follow-up and prospective studies are needed to confirm our results.

  • arteriovenous malformation
  • brain
  • liquid embolic material
  • vein
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Footnotes

  • MK and PJM contributed equally.

  • Contributors Study design: MK, PJM, CPS, RC. Data acquisition: MK, PJM, HN, MH, JK, APN, AES, CPS, RC. Data analysis and interpretation: MK, PJM, CPS, RC. Manuscript preparation: MK, PJM, CPS, RC. Revision of manuscript for important intellectual content: MK, PJM, CPS, RC. Approval of the final version of the manuscript: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The datasets during and/or analyzed during the current study available from the corresponding author on reasonable request.

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