Modified pressure-cooker technique (PCT) using extra-soft Kaneka coils improves embolization of high-grade cerebral arteriovenous malformations: a technical note

Endovascular embolization techniques are showing an extraordinary potential to treat patients suffering from complex neurovascular malformations. The embolization with liquid embolic agents via Onyx is a prominent approach to treat arteriovenous malformation (AVM). However, intraoperative reflux of the liquid agents can be very challenging and, thus, is impairing full success of endovascular treatment. A possible technique to prevent intraoperative endovascular reflux is the pressure-cooker technique (PCT) utilizing coils to build a wedge proximal to the AVM. Few modifications of the PCT have been developed in the recent years to improve effectiveness of embolization procedure. Hereby, we present a novel PCT modification utilizing extra-soft Kaneka coils and glue to build well-fitting wedges. After the application of extremely soft bare coils with high trackability, flexibility and crossability, liquid agents can be injected with reduced reflux. We think the pressure-cooker technique with extra-soft Kaneka coils enables more efficient embolization in even farther, tinier and more tortuous target vessels. This technical note presents two illustrative patient cases with treatment-refractory, high-grade cerebral arteriovenous malformations which were successfully treated via embolization with PCT in which the plug was formed with Kaneka coils.