RT Journal Article
SR Electronic
T1 Pressure Cooker Technique for Endovascular Treatment of Spinal Arteriovenous Fistulas: Experience in 15 Cases
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1270
OP 1275
DO 10.3174/ajnr.A7078
VO 42
IS 7
A1 Clarençon, F.
A1 Stracke, C.P.
A1 Shotar, E.
A1 Wallocha, M.
A1 Mosimann, P.J.
A1 Boch, A.-L.
A1 Sourour, N.
A1 Chapot, R.
YR 2021
UL http://www.ajnr.org/content/42/7/1270.abstract
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