double lumen balloon ascent kadziolka-k
TRANSCRIPT
Double lumen remodeling balloon:
New technique for treatment of MCA
bifurcation aneurysm
Kadziolka K, Leautaud A., Estrade L., W. Mustafa,
Pierot L.
CHU REMIS
Interventional Neuroradiology Department
France
New technology
As medical technology advances
such as stenting, remodeling,
an increasing number of intracranial
aneurysms are being addressed for
EVT.
Aneurysm morphology
MCA large, bifurcation aneurysms are
technically challenging due to the complex
anatomy.
Bifurcation aneurysms are often wide necked
and incorporate the origin of arterial branches in the
aneurysm broad base.
Endovascular therapeutic
options
Remodeling with use of hyper compliant
balloon.
Double balloon technique ( kissing balloon)
Distal round balloon technique
Stent with or without balloon
„Y” stenting ( dual antiplatelet premedicatio )
Double lumen distal remodeling balloon?
Distal round balloon technique
v
Dual lumen balloon microcatheter
Primary experience with use of novel
double lumen balloon
ASCENT 4 x 7 mm
Micrus Endovascular Corp, San Jose, California, USA
Balloon Catheter Technical
Specification
Guidewire compatibility ≤.014”
Tip length distal to balloon 3 mm
Inner lumen diameter .0170”
Outer diameter 2.9F
Marker band 3 cm from distal tip allows delivery
of embolics (Ascent 4x7 mm)
Compatible with DMSO
Guiding catheter compatibility ,050” minimum ID
Patients and Methods
A 60-year-old male presented with
unruptured left MCA bifurcation aneurysm measuring 11×7 mm with neck 4 mm.
Dome to neck ratio 2.5.
Both parents suffered from ruptured
aneurysm subarachnoid hemorrhage.
Periprocedural Medication
Systemic heparinisation: 50 IU/kg bolus infusion
followed by 1500 IU/hour.
ASA 250 mg IV.
Systemic heparinisation prolonged for 24 hours.
Endovasculare procedure
Endovasculare procedure
Results
Results
Clinical outcome at discharge was unchanged.
Anatomic angiographic outcome appears as
residual neck.
Follow-up Examination
Follow up MRI after 3 months.
DSA follow-up at 6 months after the treatment
Follow-up Examination
Follow-up Examination
Anatomic angiographic outcome
appears as complete occlusion.
Embolisation of the aneurysm with dome to
neck diameter ≥ 6mm /3 mm distal
microcatheter tip/
Rigidity of the double lumen catheter
Cigar ellipsoidal shape instade of round more
spherical
Technical difficulties and limitations
Our recomendations for use of
Ascent double lumen balloon
New compliant guide catheters 6F or coaxial
guiding platform.
Microwire .014" rather then smaller
Conclusion
Double lumen balloon provides a means to
acheive reconstruction of complex mca
bifurfation aneurysm and can be an alternative
to double balloon(kissing)technique or “Y”
stenting for some selective bifurcation
aneurysms.
Due to development of new endovascular
devices treatment of mca bifurcation becomes
safer, feasible and durable.