A comparison of dual-lumen balloon and simple microcatheters in the embolization of DAVFs and AVMs using onyx

Hafazalla, Karim; Baldassari, Michael P.; Sweid, Ahmad; Starke, Robert M.; Sajja, Kalyan; Lebovitz, Jonathon; Storey, Christopher; Herial, Nabeel; Tjoumakaris, Stavropoula; Gooch, M. Reid; Zarzour, Hekmat; Rosenwasser, Robert H.; Jabbour, Pascal

doi:10.1016/j.jocn.2020.10.007

Cited by 8 publications

(12 citation statements)

References 19 publications

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“…Navigability of DLBCs is often more difficult compared with the traditional flow guided microcatheters, given the structural requirements inherent to the dual-lumen design. 13–15 As described previously, the tortuosity encountered in all of the vessels in this pediatric series would preclude the advance of other standard DLBCs, even if they could physically fit within any of the embolized feeders. However, SMC is novel in that it has a smaller OD (Table 2) that can be navigated easily in small and tortuous distal vessels.…”

Section: Discussionmentioning

confidence: 82%

“…7 Being manufactured with a stiff distal tip, SMCs allow for easy navigability in tortuous and small-caliber arteries without the adjunct use of an intermediate catheter. [13][14][15] A smaller tip allows for better positioning closer to the nidus, thereby increasing safety and efficacy. 1,2 In addition, the ability to advance the catheter into distal small vessels and achieve flow control at the balloon level diminishes the risk of reflux proximally in the parent vessel, where essential branches might emerge from it.…”

Section: Discussionmentioning

confidence: 99%

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Initial experience with the Scepter Mini catheter for the embolization of vascular malformations in the pediatric population

et al. 2021

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Background Achieving distal access and flow control are of significant importance for the treatment of intracerebral arteriovenous shunting lesions. The Scepter Mini catheter is a low-profile, dual-lumen balloon catheter, designed to provide navigability in small-caliber, tortuous intracranial vessels. Objective To describe the initial experience of the Scepter Mini catheter in the treatment of pediatric arteriovenous malformations and fistulas. Methods A single-institution, retrospective chart review identified all consecutive uses of the Scepter Mini catheter for endovascular embolization of vascular malformations in the pediatric population. Results Three different arterial pedicles were embolized with the Scepter Mini catheter in two different patients. One patient was diagnosed with a vein of Galen malformation that had undergone multiple treatments and the other with a torcular dural arteriovenous fistula. All cases encompassed quite challenging tortuosity of small-caliber feeders which prevented the use of another microcatheter. The Scepter Mini catheter navigated into feeding arteries of diameters 0.65, 1.9, and 1.25 mm, and its balloon was inflated to achieve excellent blood flow control. Total obliteration (100%) of the shunting lesion was achieved in both cases. No reflux, pedicle rupture or other untoward effects were observed. Both patients had an uneventful recovery. Conclusion The Scepter Mini catheter afforded fast and safe distal access, flow control, and treatment of arteriovenous malformations in this initial pediatric cohort. The catheter’s low profile and easy navigability should support its use in tortuous and small arterial feeders, especially in the pediatric population.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Initial experience with the Scepter Mini catheter for the embolization of vascular malformations in the pediatric population

et al. 2021

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“…Thus, procedural time and radiation exposure may be reduced. 2,7,11,18,21 Moreover, the inflated balloon reduces the risk of proximal reflux of the LEA, which has two significant advantages: First, it allows the interventionalist to inject larger volumes (Table 3), 7 thereby potentially achieving higher rates of complete occlusion. In addition, by preventing reflux, DLBCs decrease the risk of occlusion of non-targeted or functional vessels.…”

Section: Discussionmentioning

confidence: 99%

“…6 Importantly, balloon inflation prevents reflux during liquid embolic agent (LEA) injection while improving distal penetration, potentially leading to reduced complications, better outcomes, and shorter procedural times. 7,8…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of dual lumen balloon catheters for the Treatment of cerebral vascular malformations: A systematic review, pooled analysis, and meta-analysis

et al. 2022

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Background There is little evidence in scientific literature assessing the safety and efficacy of dual-lumen balloon catheters (DLBCs) and their performance compared to single-lumen catheters (SLCs). Methods In this PROSPERO-registered, PRISMA-compliant systematic review, we identified all MEDLINE and EMBASE single-arm (DLBCs) and double-arm (DLBCs vs SLCs) cohorts where DLBCs were used for the treatment of cerebral arteriovenous malformations (AVMs) or dural arteriovenous fistulas (dAVFs). Immediate angiographic outcome, vascular complications, technical failures, reflux episodes and entrapment were the primary outcomes. A meta-analysis of the double-arm studies summarized the primary outcomes of total procedural time and immediate angiographic outcome. Results The authors identified 18 studies encompassing 209 treated lesions with reported outcomes. Complete occlusion was achieved in 108/132 treated dAVFs (81.8%, 95% CI: [74–87.8%]) and in 45/77 treated AVMs (58.4%, [46.7–69.4%]). The proportion of completely occluded dAVFs was statistically significantly higher than that of AVMs, p < .001. There were eight reported vascular complications (3.8%, [1.8–7.7%]), five technical failures (2.4%, [0.9–5.8%]), 14 reflux events (6.7%, [3.9–11.2%]), two entrapment events (1%, [0.2–3.8%]) and 0 deaths (mortality rate 0%, [0–2.3%]). In a meta-analysis for the treatment of dAVFs, the total procedural time was significantly less for DLBCs compared to SLCs (64.9 vs 125.7 min, p < .0001). The odds of complete immediate occlusion were significantly higher with DLBCs compared to SLCs (odds ratio (OR) 4.6, [1.5–14.3], p = .008). Conclusion Dual-lumen balloon catheters are safe and effective for the embolization of cerebral AVMs and dAVFs and can achieve faster and potentially superior results compared to SLCs. Registration-URL https://www.crd.york.ac.uk/prospero/ Unique Identifier: CRD42021269096

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“…1,2,4–6,9,10,12,13 Similar to the utilization of the DLBM to embolize high-flow AVM, inflation of the balloon can reduce proximal blood flow and facilitate the distribution control of copolymer agents such as Onyx. 7,14,15 In general, detachable coils can be delivered and readily detached using microcatheters with a distal inner diameter of >0.015 in. 16 The inner lumen of the Scepter balloon employed here has a diameter of 0.0165 in, which is similar to the common 0.017-in microcatheter, thereby permitting the use of a standard 0.014-in microwire 2,3 suitable for coil delivery.…”

Section: Discussionmentioning

confidence: 99%

Rescue embolization with direct coil delivery from dual-lumen balloon microcatheter

Chen

Hsieh

et al. 2021

Interv Neuroradiol

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Background Balloon microcatheters are widely used for endovascular treatment. However, no reports on direct coil embolization from dual-lumen balloon microcatheters are available in the literature. This report is the first description of direct coil embolization using this type of balloon microcatheter for looming bleeding emergencies. Methods This retrospective review demonstrates the indications and advantages of coil embolization from an inflated balloon catheter to reduce blood loss and simultaneously occlude bleeding. Results Five patients who underwent emergency endovascular treatment using coil embolization directly delivered from a dual-lumen balloon were identified. Etiologies included vertebro-vertebral arteriovenous fistula, ruptured vertebral artery dissecting aneurysm, vertebral artery injury during cervical spinal operation, and failed stent retrieval procedures for acute infarction. Complete hemostasis was achieved with all procedures. Conclusion Our experience demonstrates the feasibility of direct coil embolization by using a dual-lumen balloon to rapidly halt bleeding in some rare emergency situations, which may save lives.

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A comparison of dual-lumen balloon and simple microcatheters in the embolization of DAVFs and AVMs using onyx

Cited by 8 publications

References 19 publications

Initial experience with the Scepter Mini catheter for the embolization of vascular malformations in the pediatric population

Initial experience with the Scepter Mini catheter for the embolization of vascular malformations in the pediatric population

Safety and efficacy of dual lumen balloon catheters for the Treatment of cerebral vascular malformations: A systematic review, pooled analysis, and meta-analysis

Rescue embolization with direct coil delivery from dual-lumen balloon microcatheter

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