Comprehensive assessment of the feasibility, safety, and efficacy of the pressure cooker technique in the treatment of brain arteriovenous malformations: Systematic review and meta-analysis

Ferreira M.Y.; Barros E.A.; Günkan A.; Scarramal J.P.L.; Cheidde L.; de Oliveira Almeida G.; Cardoso L.J.C.; de Souza Duarte M.; Maia H.G.; Bertani R.; Bocanegra-Becerra J.E.; Brenner L.B.O.; Ferreira C.; Gordon D.; Ellis J.A.; Serulle Y. · Neurosurgical Review (2025) · DOI: 10.1007/s10143-025-03620-z

Resumen

Purpose: The Pressure Cooker Technique (PCT) is an endovascular technique for brain arteriovenous malformations (bAVMs) that can minimize reflux and inadvertent embolization compared with conventional techniques, leading to a safer and more controlled embolization. This systematic review and meta-analysis aimed to assess the feasibility, safety, and efficacy of PCT for bAVMs. Methods: We searched PubMed, Embase, and Web of Science databases. Eligible studies included ≥ 4 patients employing PCT for bAVMs and reporting on clinical and angiographic outcomes. We used single-proportion analysis with 95% confidence intervals under a random-effects model to pool the data. Transvenous (TVE) and transarterial (TAE) approaches were analyzed separately. Results: Eight observational studies involving 168 patients, 106 treated by TVE and 62 by TAE, were included. The immediate complete obliteration rate was 97% (94%-100%) with TVE and 70% (38%-100%) with TAE. Procedure failure rate was 3% (0%-6%) and 0% (0%-3%) for TVE and TAE, respectively. Intracranial hemorrhagic complications were the most prevalent, with a 13% rate (3%-23%) in TVE. A good clinical outcome rate (Modified Rankin Scale ≤ 2) was 93% (82%-100%) in the TVE. Recurrence was 0% (0%-10%) in the TVE. The surgical retreatment rate was 11% (3%-19%) and 49% (36%-62%) in TVE and TAE, respectively. Conclusion: This systematic review and meta-analysis found that PCT is highly feasible, safe, and effective in treating bAVMs. Given the current evidence, PCT may be considered a valuable option for the treatment of high-grade bAVMs. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2025.

Instituciones: Universidad Peruana Cayetano Heredia