nach oben

Erschienen in:

04.07.2023 | Original Article

Balloon Pressure Technique with the Scepter Mini Balloon as Part of the Endovascular Strategy for Brain Arteriovenous Malformations Embolization

Preliminary Multicenter Experience

verfasst von: Frédéric Clarençon, Chrysanthi Papagiannaki, Suzanna Saleme, Aymeric Rouchaud, Eimad Shotar, Emily Rius, Julien Burel, Anne-Laure Boch, Nader-Antoine Sourour, Charbel Mounayer

Erschienen in: Clinical Neuroradiology | Ausgabe 4/2023

Einloggen, um Zugang zu erhalten

Abstract

Background

The balloon pressure technique (BPT) is an alternative to the pressure cooker technique. A dual lumen balloon (DLB) is used to inject the liquid embolic agent through the working lumen while the balloon is inflated. The purpose of our study was to report our early experience using the Scepter Mini dual lumen balloons for BPT in brain arteriovenous malformation (bAVM) embolization.

Material and Methods

Consecutive patients treated from July 2020 to July 2021 in 3 tertiary centers using the BPT with low-profile dual lumen balloons (Scepter Mini, Microvention, Tustin, CA, USA) by endovascular means for bAVMs were retrospectively reviewed. Patient demographics and bAVM angio-architectural features were collected. The feasibility of Scepter Mini balloon navigation close to the nidus was evaluated. Technical as well as clinical (ischemic and/or hemorrhagic) complications were also systematically assessed. The occlusion rate was evaluated on follow-up DSA.

Results

A total of 19 patients (10 females; mean age = 38.2 years) consecutively treated for a bAVM (8 ruptured/11 unruptured) using the BPT with a Scepter Mini through 23 embolization sessions were included in our series. Navigation of the Scepter Mini was feasible in all cases. Of the patients 3 (16%) had procedure-related ischemic stroke and 2 patients (10.5%) had late hemorrhages. None of these complications led to severe permanent sequela. Complete occlusion of bAVM embolized with intention to cure was recorded in 11/13 cases (84.6%).

Conclusion

The BPT using low-profile dual lumen balloons is feasible and seems safe for embolization of bAVMs. It may help to reach high occlusion rates, especially when performed in the intent to cure by embolization only.

Pollock BE, Flickinger JC, Lunsford LD, et al. Factors that predict the bleeding risk of cerebral arteriovenous malformations. Stroke. 1996;27(1):1–6. https://doi.org/10.1161/01.str.27.1.1.CrossRefPubMed

Al-Shahi R, Bhattacharya JJ, Currie DG, et al. Prospective, population-based detection of intracranial vascular malformations in adults: the Scottish Intracranial Vascular Malformation Study (SIVMS). Stroke. 2003;34(5):1163–9. https://doi.org/10.1161/01.STR.0000069018.90456.C9.CrossRefPubMed

Solomon RA, Connolly ES Jr. Arteriovenous malformations of the brain. N Engl J Med. 2017;376(19):1859–66. https://doi.org/10.1056/NEJMra1607407. published Online First: 2017/05/11.CrossRefPubMed

Shotar E, Debarre M, Sourour NA, et al. Retrospective study of long-term outcome after brain arteriovenous malformation rupture: the RAP score. J Neurosurg. 2018;128(1):78–85. https://doi.org/10.3171/2016.9.JNS161431.CrossRefPubMed

Hashimoto N, Nozaki K, Takagi Y, et al. Surgery of cerebral arteriovenous malformations. Neurosurgery. 2007;61(1 Suppl):375–87. https://doi.org/10.1227/01.NEU.0000255491.95944.EB. discussion 87–9.CrossRefPubMed

Raymond J, Iancu D, Weill A, et al. Embolization as one modality in a combined strategy for the management of cerebral arteriovenous malformations. Interv Neuroradiol. 2005;11(Suppl 1):57–62. https://doi.org/10.1177/15910199050110S110.CrossRefPubMedPubMedCentral

Pierot L, Cognard C, Herbreteau D, et al. Endovascular treatment of brain arteriovenous malformations using a liquid embolic agent: results of a prospective, multicentre study (BRAVO). Eur Radiol. 2013;23(10):2838–45. https://doi.org/10.1007/s00330-013-2870-6.CrossRefPubMed

Chapot R, Stracke P, Velasco A, et al. The pressure cooker technique for the treatment of brain AVMs. J Neuroradiol. 2014;41(1):87–91. https://doi.org/10.1016/j.neurad.2013.10.001.CrossRefPubMed

Koyanagi M, Mosimann PJ, Nordmeyer H, et al. The transvenous retrograde pressure cooker technique for the curative embolization of high-grade brain arteriovenous malformations. J Neurointerv Surg. 2021;13(7):637–41. https://doi.org/10.1136/neurintsurg-2020-016566.CrossRefPubMed

10.

He Y, Bai W, Xu B, et al. Perioperative complications of transvenous embolization of ruptured Intracranial arteriovenous malformations. Front Neurol. 2022; https://doi.org/10.3389/fneur.2022.873186.CrossRefPubMedPubMedCentral

11.

Clarencon F, Perot G, Biondi A, et al. Use of the Ascent balloon for a 2-in‑1 remodeling technique: feasibility and initial experience: case report. Neurosurgery. 2012;70(1 Suppl Operative):170–3. https://doi.org/10.1227/NEU.0b013e31822c49ad. discussion 73.CrossRefPubMed

12.

Clarencon F, Di Maria F, Gabrieli J, et al. Double-lumen balloon for Onyx(R) embolization via extracranial arteries in transverse sigmoid dural arteriovenous fistulas: initial experience. Acta Neurochir. 2016;158(10):1917–23. https://doi.org/10.1007/s00701-016-2906-1.CrossRefPubMed

13.

Paramasivam S, Niimi Y, Fifi J, et al. Onyx embolization using dual-lumen balloon catheter: initial experience and technical note. J Neuroradiol. 2013;40(4):294–302. https://doi.org/10.1016/j.neurad.2013.08.001.CrossRefPubMed

14.

von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573–7. https://doi.org/10.7326/0003-4819-147-8-200710160-00010.CrossRef

15.

Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg. 1986;65(4):476–83. https://doi.org/10.3171/jns.1986.65.4.0476.CrossRefPubMed

16.

Hafazalla K, Baldassari MP, Sweid A, et al. A comparison of dual-lumen balloon and simple microcatheters in the embolization of DAVFs and AVMs using onyx. J Clin Neurosci. 2020;81:295–301. https://doi.org/10.1016/j.jocn.2020.10.007.CrossRefPubMed

17.

Clarencon F, Shotar E, Pouvelle A, et al. Spinal epidural arteriovenous fistula embolization with ethylene vinyl alcohol (EVOH) copolymer using the Scepter Mini dual-lumen balloon. J Neurointerv Surg. 2021;13(5):492. https://doi.org/10.1136/neurintsurg-2020-016395.CrossRefPubMed

18.

Pulli B, Sussman ES, Mayercik V, et al. Initial experience with the Scepter Mini dual-lumen balloon for transophthalmic artery embolization of anterior cranial fossa dural arteriovenous fistulae. J Neurointerv Surg. 2020;12(11):1132–6. https://doi.org/10.1136/neurintsurg-2020-016013.CrossRefPubMed

19.

Vollherbst DF, Chapot R, Wallocha M, et al. First clinical multicenter experience with the new Scepter Mini microballoon catheter. J Neurointerv Surg. 2021;13(3):261–6. https://doi.org/10.1136/neurintsurg-2020-016115.CrossRefPubMed

20.

White TG, Shah KA, Turpin J, et al. Single institution early clinical experience with the Scepter Mini balloon catheter. Neuroradiol J. 2021;34(6):562–7. https://doi.org/10.1177/19714009211013495.CrossRefPubMedPubMedCentral

21.

Mehta T, Hassan A, Masood K, et al. The next step in balloon assisted endovascular neurosurgical procedures: a case series of initial experience with the scepter mini balloon microcatheter. Interv Neuroradiol. 2021;27(2):298–306. https://doi.org/10.1177/1591019920972884.CrossRefPubMed

22.

Al Raaisi A, Gabrieli J, Sourour NA, et al. Dual lumen balloon spontaneous inflation during embolization. Clin Neuroradiol. 2019;29(2):365–9. https://doi.org/10.1007/s00062-018-0716-y.CrossRefPubMed

Titel: Balloon Pressure Technique with the Scepter Mini Balloon as Part of the Endovascular Strategy for Brain Arteriovenous Malformations Embolization
Preliminary Multicenter Experience
verfasst von: Frédéric Clarençon
Chrysanthi Papagiannaki
Suzanna Saleme
Aymeric Rouchaud
Eimad Shotar
Emily Rius
Julien Burel
Anne-Laure Boch
Nader-Antoine Sourour
Charbel Mounayer
Publikationsdatum: 04.07.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Neuroradiology / Ausgabe 4/2023
Print ISSN: 1869-1439
Elektronische ISSN: 1869-1447
DOI: https://doi.org/10.1007/s00062-023-01309-8

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Balloon Pressure Technique with the Scepter Mini Balloon as Part of the Endovascular Strategy for Brain Arteriovenous Malformations Embolization

Preliminary Multicenter Experience