Balloon-Assisted Coil Embolization and Balloon Angioplasty for Post Subarachnoid Hemorrhage Vasospasm: Initial Experience with Scepter Mini Balloon

Ioannidis Ioannis,Adamou Antonis,Nasis Nikolaos,Vlychou Marianna,Poullos Nektarios 대한신경중재치료의학회 2022 Neurointervention Vol.17 No.2

The scope of this technical note is to report our experience with balloon remodeling for wideneck aneurysms and balloon angioplasty of post-subarachnoid hemorrhage vasospasm using the novel Scepter Mini balloon (SMB). Five cases were treated with balloon remodeling for aneurysmal subarachnoid hemorrhage, 2 of which were additionally treated with angioplasty due to post-bleeding vasospasm. All patients had their aneurysm located on parent vessels with a diameter smaller than 2 mm. Complete occlusion was noted in all aneurysms, and the patients had no short-term complications attributed to the catheterization. Additionally, we confirm the previously reported smooth navigation of the balloon through vessels with tortuous anatomy without catheter-induced vasospasm. Based on our experience, the SMB can be a safe and efficient device for applying the balloon remodeling technique for distally located wide-neck aneurysms and distal balloon angioplasty.

A safer endovascular technique for pre-operative embolization of juvenile nasopharyngeal angiofibroma: avoiding the pitfalls of external carotid artery – internal carotid artery anastomoses

David Rosenbaum-Halevi,Victor Lopez-Rivera,Ali Turkmani,Aditya Sanzgiri,Hussein A. Zeineddine,Amber Luong,Peng Roc Chen 대한뇌혈관외과학회 2020 Journal of Cerebrovascular and Endovascular Neuros Vol.22 No.2

Intra-arterial embolization of juvenile nasopharyngeal angiofibroma (JNA) prior to surgical resection is the preferred approach to minimize blood loss during surgical resection of the tumor. However, the presence of external carotid artery–internal carotid artery (ECA-ICA) anastomoses may hinder complete tumor embolization due to the associated risk for embolic complications. Here, we evaluate the use of a balloon-assisted embolization (BAE) technique in the treatment of JNA. We conducted a retrospective review of JNA patients who underwent tumor embolization with injection of Onyx in a single session between 2013-2018. All cases displayed tumor arterial supply from ECA and ICA circulations on 2-D catheter angiograms. Procedural and surgical outcome data were analyzed. Results are given as mean±- standard deviation (range). Among 9 patients with JNA, all were males and mean age was 14.1±6.3 years (range, 9-29 years). The mean tumor volume embolization was 84.4±12.4% (range, 60-100%) and in 89% patients ≥80% of tumor volume embolization was achieved. There were no embolization-related complications reported. During surgical resection of the tumor there was a low average surgical blood loss of 722±651.5 mL (range, 50-2,000 mL) and the mean procedure time was 282.6±85.4 mins (range, 151-403 mins). In this series, the BAE technique showed to be a safe and effective approach to achieve successful tumor embolization while avoiding embolic complications and effectively reducing the risk for blood loss during surgical resection.

Efficiency of Air Bubble Removal in Preparation of Low-Profile Angioplasty Balloon Catheter: Bench-Top Comparison of Six Methods

최준호,황선문,Lee Deok Hee 대한신경중재치료의학회 2019 Neurointervention Vol.14 No.1

Purpose: Complete removal of air bubbles from balloons for neurovascular angioplasty is cumbersome. We compared the preparation difficulty, air removal efficiency, and air collection pattern of six different balloon catheter preparation methods to propose a better preparation method for both initial and second balloon uses, especially for small-profile angioplasty balloon catheters. Materials and Methods: A total of 18 neurovascular angioplasty balloon catheters with nominal diameters of 2 mm were prepared to test six different preparation methods: the instruction for use method (method A), simplified method using a syringe (method B) and four newly devised preparation methods using inflating devices (methods C–F). Serial radiographs were obtained while the balloons were gradually inflated. We measured the time for each preparation and the bubble number, analyzed their distribution in the balloon, and calculated the contrast filling ratio (contrast filling area/total balloon area) for initial and second ballooning. The whole process was repeated three times. Results: The preparation time varied widely (11.5 seconds [method D] to 73.3 seconds [method A]). On initial inflation, the contrast filling ratio at 8 atm was the highest (100%) with methods A and F. On second inflation, the ratio was again highest with method A (99.5%), followed by method F (99.2%). Initial ballooning tended to show a uniform pattern of single bubble in the distal segment of the balloon; in contrast, second ballooning showed varying patterns in which the bubbles were multiple and randomly distributed. Conclusion: None of the six methods were able to completely exclude air bubbles from the balloon catheters including the second ballooning; however, the method of repeating aspiration with high-volume inflating device (method F) could be a practical option considering the simplicity and efficiency of preparation.

Initial experience with Scepter Mini dual lumen balloon for embolization of cerebrovascular diseases

Muhammad U Manzoor,Ibrahim A. Almulhim,Abdullah A. Alrashed,Shorog Althubait,Abdulrahman Y. Alturki,Sultan M. Al-Qahtani 대한뇌혈관외과학회 2023 Journal of Cerebrovascular and Endovascular Neuros Vol.25 No.2

Objective: Endovascular treatment of cerebrovascular diseases is often challenging due to small caliber, tortuous distal vessels. Several devices and techniques have evolved to overcome these challenges. Recently, a low profile dual lumen microballoon catheter, specifically designed for distal navigation is employed for neurovascular procedures. Due to its recent advent, scarce data is available on clinical utility and safety of Scepter Mini. The aim of this case series is to report our initial experience with Scepter Mini in the management of various cerebrovascular diseases.Methods: All interventional neurovascular cases performed using Scepter Mini between January 2020 till April 2021 were included. Data regarding patient demographics, procedural details and complications was retrospectively collected from patient’s electronic medical record and procedure reports.Results: Total twelve embolization procedures were performed in eleven patients, including six brain arteriovenous malformation, two dural arteriovenous fistula, one vein of Galen malformation and three hyper-vascular glomus tumor embolizations. All procedures were successfully performed with adequate penetration of the embolic agent. Complete embolization was performed in six procedures, while intended partial embolization was performed in the rest of procedures. Scepter Mini was solely used in ten procedures, however in the other two embolization procedures it was used as an additional conjunct tool to complete the intended embolization. No balloon related complication was observed in any procedure.Conclusions: Scepter Mini dual lumen microballoon catheter is safe and feasible for delivery of liquid embolic agents for cerebrovascular embolization procedures.

경동맥소체 부신경절종의 수술 전 경동맥 폐색검사 및 종양 색전술: 단일 기관에서 20년간의 경험 및 문헌 고찰

심재현,정광윤,이태훈,권민수,백승국 대한이비인후과학회 2022 대한이비인후과학회지 두경부외과학 Vol.65 No.12

Background and Objectives Carotid body paraganglioma is the common type of carotidbody tumor for which angiography, carotid artery balloon occlusion test (BOT) and tumorembolization could be considered before the surgery. We analyzed cases in a single instituteand reviewed related literature to investigate the necessity of these preoperative examinations. Subjects and Method Medical records of patients who were diagnosed with paragangliomawere retrospectively analyzed from 2000 to 2019. Results Sixteen patients were identified. Of the total, 14 patients underwent surgery at thisinstitute, and 13 underwent angiography. Of the 13 patients who underwent angiography, 6patients underwent carotid artery BOT, and 12 patients underwent tumor embolization. Theaverage tumor size of 6 patients who underwent carotid artery BOT was 28.7 mm, and 8 patientswho did not undergo carotid artery BOT was 30.1 mm. The average tumor size of 12 patientswho underwent tumor embolization was 29.4 mm. Two patients did not undergo tumorembolization, and their average tumor size was 30 mm. In 1 patient, both preoperative angiographyand carotid artery BOT were performed, but tumor embolization was not performeddue to spasm of tumor vessels. Conclusion Preoperative carotid artery BOT can be performed to reduce side effects in patientswith the potential for carotid resection. In addition, tumor embolization is performed regardlessof tumor size. By reducing the amount of bleeding during surgery and reducing thesize of the tumor, it is possible to secure an appropriate surgical field of view to facilitate operationduring surgery; however, its effectiveness needs to be clearly identified.

Transarterial Balloon-assisted Onyx Embolization of Intracranial Arteriovenous Malformations Using a Dual-lumen Balloon Microcatheter: Two Case Reports

김상흠,김태곤,공민호 대한뇌혈관외과학회 2017 Journal of Cerebrovascular and Endovascular Neuros Vol.19 No.3

The Onyx system has been well established in recent years as a very important material in the treatment of arteriovenous malformations (AVMs). When using the Onyx, it is essential to wait for the creation of a plug around the tip of the catheter, which enables the effective forward penetration of Onyx. Recent reports have shown that the introduction of a dimethyl sulfoxide compatible dual-lumen balloon microcatheter improves the efficiency of AVM embolization. We report our recent experience of two cases of intracranial AVM embolization using Onyx and the transarterial balloon-assisted technique. In both cases, the procedures were successfully performed and the nidus of the AVM was totally occluded in a relatively short time. This technique may enable immediate forward flow and penetration of Onyx without concern about reflux. It may also reduce the procedure time and increase the angiographic occlusion rate. Navigation of the dual-lumen balloon microcatheter nevertheless remains a challenge.

Perspective of the comparative effectiveness of non-pharmacologic managements on postpartum hemorrhage using a network meta-analysis

( Kyung Ju Lee ),( Kwan Hong ),( Hari Hwang ),( Hijeong Choi ),( Sangho Sohn ) 대한산부인과학회 2020 Obstetrics & Gynecology Science Vol.63 No.5

Objective Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide and is both unpredictable and inevitable. While uterotonic drugs are routinely recommended, there is ongoing debate on the ideal intervention to control uterine bleeding. This review aims to compare the use of non-pharmacologic treatments with peripartum hysterectomy in cases of life-threatening uncontrolled obstetric hemorrhage. The review’s objective is to use a network meta-analysis to help prevent maternal deaths and rank the treatments according to success rates. Methods We searched MEDLINE (PubMed), Embase, and the Cochrane Library, from January 2014 until December 2018. A second search was carried out in April 2019 before the final data analysis. Network meta-analysis allows for the calculation of the effect size between treatment groups through indirect treatment comparison. Results We confirmed that balloon-assisted management is the best intervention for uncontrolled postpartum bleeding with pharmacologic treatment. This is followed by uterine artery embolization and surgical procedures, which can help avoid the need for a hysterectomy. The balloon tamponade demonstrated lower failure rate than the surgical procedure with odds ratio (OR) of 0.44 and 95% confidence intervals (CIs) 0.50-30.54. Uterine artery embolization had a lower risk for hysterectomy than the surgical procedure group (OR, 0.74; 95% CI, 0.22-2.50). Conclusion For the quick treatment of postpartum bleeding, balloon tamponade is the best method for uncontrolled postpartum bleeding with pharmacologic treatment, followed by uterine artery embolization and surgical procedures.

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

노명호,김병문,서상현,김동준,김동익 대한영상의학회 2013 Korean Journal of Radiology Vol.14 No.5

Objective: A 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 Methods: Seventeen 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 CTM or Scepter XCTM) 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. Results: Coil 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. Conclusion: In 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.

Gastric variceal hemorrhage treated with percutaneous transhepatic embolization with balloon-occluded antegrade transvenous obliteration

Prasoon P. Mohan,Jesus Beltran-Perez,Preeti P. Ahlman 소화기인터벤션의학회 2019 Gastrointestinal Intervention Vol.8 No.4

We report a case of gastric variceal hemorrhage where high model for end-stage liver disease score and the complex gastric variceal anatomy precluded the use of both transjugular intrahepatic porto-systemic shunt and standard balloon-occluded retrograde transvenous occlusion (BRTO) procedures respectively. The patient was successfully managed by percutaneous transhepatic coil embolization combined with BRTO. It is of great importance to obtain an accurate cross-sectional image to evaluate the anatomical variances of gastric varices that will lead to appropriate vascular access and to chose a suitable embolization method.

Gastric variceal hemorrhage treated with percutaneous transhepatic embolization with balloon-occluded antegrade transvenous obliteration

Prasoon P. Mohan,Jesus Beltran-Perez,Preeti P. Ahlman 소화기인터벤션의학회 2019 International journal of gastrointestinal interven Vol.8 No.4

We report a case of gastric variceal hemorrhage where high model for end-stage liver disease score and the complex gastric variceal anatomy precluded the use of both transjugular intrahepatic porto-systemic shunt and standard balloon-occluded retrograde transvenous occlusion (BRTO) procedures respectively. The patient was successfully managed by percutaneous transhepatic coil embolization combined with BRTO. It is of great importance to obtain an accurate cross-sectional image to evaluate the anatomical variances of gastric varices that will lead to appropriate vascular access and to chose a suitable embolization method.