PT - JOURNAL ARTICLE AU - Koyanagi, Masaomi AU - Mosimann, Pascal John AU - Nordmeyer, Hannes AU - Heddier, Markus AU - Krause, Juergen AU - Narata, Ana-Paula AU - Serwi, Ahmed El AU - Stracke, Christian Paul AU - Chapot, René TI - The transvenous retrograde pressure cooker technique for the curative embolization of high-grade brain arteriovenous malformations AID - 10.1136/neurintsurg-2020-016566 DP - 2021 Jul 01 TA - Journal of NeuroInterventional Surgery PG - 637--641 VI - 13 IP - 7 4099 - http://jnis.bmj.com/content/13/7/637.short 4100 - http://jnis.bmj.com/content/13/7/637.full SO - J NeuroIntervent Surg2021 Jul 01; 13 AB - 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.Data are available upon reasonable request. The datasets during and/or analyzed during the current study available from the corresponding author on reasonable request.