Initial Experience with the New Double-lumen Scepter Balloon Catheter for Treatment of Wide-necked Aneurysms

Abstract

ObjectiveA new double-lumen balloon catheter was being developed for the treatment of cerebral aneurysms. The purpose of this study is to report our initial experience of a double-lumen balloon catheter for the treatment of wide-necked aneurysms.Materials and MethodsSeventeen patients (mean age, 63 years; range, 45-80 years) with wide-necked, with or without a branch-incorporated aneurysms, (10 ruptured and 9 unruptured) were treated with balloon-assisted coil embolization using a double-lumen balloon catheter (Scepter C™ or Scepter XC™) for 7 months after being introduced to our country. Locations of the aneurysms were posterior communicating artery (n = 7), anterior communicating artery or A2 (n = 7), middle cerebral artery (MCA) bifurcation (n = 3), basilar artery tip (n = 1) and anterior choroidal artery (n = 1). The initial clinical and angiographic outcomes were retrospectively evaluated.ResultsCoil embolization was successfully completed in all 19 aneurysms, resulting in complete occlusions (n = 18) or residual neck (n = 1). In one procedure, a thrombus formation was detected at the neck portion of the ruptured MCA bifurcation aneurysm near to the end of the procedure. It was completely resolved with an intra-arterial infusion of Glycoprotein IIb/IIIa inhibitor (Tirofiban, 1.0 mg) without any clinical sequela. There were no treatment-related events in the remaining 18 aneurysms. At discharge, functional neurological state improved in 11 patients (10 patients with ruptured aneurysm and 1 with unruptured aneurysm presenting with mass symptoms) and 6 patients with unruptured aneurysms had no newly developed symptoms.ConclusionIn this preliminary case series, the newly developed double-lumen Scepter balloon appears to be a safe and convenient device for coil embolization of wide-necked aneurysms.

Combination of Multicatheter Plus Stent or Balloon for Treatment of Complex Aneurysms

“…For the complex aneurysms initially treated with the combination technique, it was anticipated that the multicatheter, balloon, or stent alone could not achieve preservation of an incorporated branch or stability of the coil basket due to a wide neck with incorporated branches and/or deep lobulation (Fig 3). Given the accumulation of experience since the previously reported cases series, 6,9,11,12 the complexity of the technique used has not limited the ability to obtain satisfactory results. In the cases focused on preserving an incorporating branch, interleaving 2 coils stabilized the initial coil basket to preserve the incorporated branch, while the overinflated balloon prevented coils from moving toward the incorporated branch (Fig 1).…”

“…Furthermore, the combination strategy for complex aneurysms had a safety and effectiveness favorably comparable with the single adjunctive endovascular techniques in previous studies. [1][2][3]8,9,[13][14][15][17][18][19][22][23][24][25][26] Our study had several limitations due to its retrospective design and the relatively small number of cases. Therefore, the se- lection bias was inevitable, but it might be somewhat lowered because our data of endovascular treatment were consecutively and prospectively registered.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12] However, if wide-neck aneurysms have an incorporated branch and/or deeply lobulated sac, coiling is more difficult and there is potentially an increased risk of incomplete coiling, a thromboembolic event, or branching occlusion and posttreatment recurrence. The unique configuration of this aneurysm usually demands a more elaborate coiling technique and can be recognized as a complex and difficult aneurysm in view of the coiling procedure.…”

Tirofiban combined with urokinase selective intra-arterial thrombolysis for the treatment of middle cerebral artery occlusion

“…Furthermore, after the drugs were injected into the animals via intracerebral arteries, no new intracerebral hemorrhage was detected. Recently, the application of ultraselective intra-arterial tirofiban thrombolysis has been reported to be safe and effective for the treatment of acute thrombotic events occurring during the treatment procedure of rupture or non-ruptured aneurysm embolization, and the incidence of intracranial hemorrhage was reported to be low (20,(22)(23)(24)(25). The ultraselective intra-arterial injection of tirofiban may enable the dosage to be reduced while improving the local drug concentration at the thrombotic site and reducing the thrombolysis-induced systemic fibrinolysis and the incidence of intracranial hemorrhage (10,20,26).…”

Intra-arterial infusion of tirofiban and urokinase for thromboembolic complications during coil embolization of ruptured intracranial aneurysms

“…Superselective intra-arterial administration of tirofiban are an effective method for treating acute ischemic complications during interventional treatment of aneurysms, ruptured or non-ruptured (3-5, 7,13,17). These inhibitors exert their thrombolytic action via many mechanisms including: 1) inhibiting platelet aggregation, resulting in a reduced thrombus size and a platform for further thrombin synthesis; 2) preventing local release of inhibitors for thrombolysis from platelets; 3) promoting endogenous thrombolysis by breaking down aggregated platelets; and 4) reducing platelet-mediated clot retraction and the gel elastic modulus (12).…”