*3.2.3 Pressure cooker technique*

Pressure cooker technique (PCT), first described by Chapot et al. [50], applies a plug composed of coils and glue instead of the usual ETOH plug used in the regular plug and push technique. Coils are deployed and NBCA is injected to form a plug. A microcatheter for ETOH injection is placed in the optimal position in the feeding artery followed by a second microcatheter placed in between the tip of the first microcatheter and detachment zone. As described by the sheeping technique, placement of the first microcatheter usually facilitates the navigation of the second security microcatheter [32, 51]. A 1.2F Magic (Balt, Montmorency, France) microcatheter is used in small caliber vessels and Echelon 10 (Medtronic, Irvine, CA, USA) is used as a second microcatheter in relatively larger caliber arterial feeders. Since detachable coils are not compatible with Magic 1.2F microcatheter, injectable flow coils (SPIF, Balt, Montmorency, France) are used. In case of larger caliber

vessels with high flow arteriovenous shunts, injectable coils may flow unintentionally toward the tip of the first microcatheter. Detachable coils are deployed through a regular 1.7F like Echelon 10 (Medtronic, Irvine, CA, USA) for precise placement of the coil and glue plug. This type of plug is more resistant to ETOH reflux and facilitates a more forceful and continuous ETOH injection. It creates a wedge-like position similar to ETOH injection through the balloon microcatheters. The theoretical advantages compared to balloon-assisted embolization are better navigability of flow-directed microcatheters and avoidance of risk of vessel perforation during balloon inflation.
