Combined use of a double-lumen remodeling balloon and a low-profile stent in the treatment of intracranial aneurysms (‘remostent’ technique): A technical note

Kądziołka, Krzysztof; Tomas, Catherine; Robin, Georges; Piérot, Laurent

doi:10.1016/j.neurad.2012.11.001

Cited by 13 publications

(12 citation statements)

References 3 publications

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“…Our series has several limitations, such as a low number of patients, and the non-inclusion of patients with spinal vascular malformations. It should also be noted that whereas the Scepter Mini balloon microcatheter does seem to have better navigability within small distal intracranial vessels, it does not permit placement of coils 4 , 20 or delivery of intracranial stents 21 , 22 quite unlike the case with other dual lumen balloon microcatheters such as the Scepter C and XC. However, our series does suggest the potential for wider utilization of this low-profile dual lumen balloon microcatheter for some balloon assisted endovascular neurosurgical procedures, in which distal navigability and a smaller profile for the balloon are more important.…”

Section: Discussionmentioning

confidence: 99%

The next step in balloon assisted endovascular neurosurgical procedures: A case series of initial experience with the Scepter Mini balloon microcatheter

et al. 2020

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Background The use of compliant dual lumen balloon microcatheters (CDLB) for the endovascular treatment of vascular malformations, wide neck aneurysms, and intracranial angioplasty (for vasospasm) is well documented. Navigation of 4 mm or larger CDLB within tortuous and small distal intracranial vessels can be challenging. Recently, the lower profile Scepter Mini balloon microcatheter (SMB) has been approved for use, with potential for improved intracranial navigation. Objective Discuss operative experience of Scepter Mini (Microvention, Aliso Viejo, CA). Methods We describe our initial experience with the SMB in a series of nine patients. Results The balloon microcatheter was used for delivery of liquid embolic in six patients (Case 1, 2, 6–9), adjunct support for delivery or positioning of the Woven Endobridge (WEB) device in two (Case 3,4), and gentle post-deployment repositioning of a WEB device in the last one (Case 5). We were able to successfully navigate the SMB over a 0.008 “micro wire to the target lesion in all the patients. We experienced initial difficulty with injecting liquid embolic in Case 2. We postulate that the SMB was in a tortuous segment of a dural vessel in this patient, and that it kinked on inflation with occlusion of the liquid embolic delivery lumen; this was overcome with slightly proximal repositioning and reinflation of the SMB. Conclusion Our initial experience shows that the SMB has potential to be useful in endovascular neurosurgical procedures requiring balloon assistance within smaller diameter blood vessels.

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Section: Discussionmentioning

confidence: 99%

The next step in balloon assisted endovascular neurosurgical procedures: A case series of initial experience with the Scepter Mini balloon microcatheter

et al. 2020

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“…Stent coil embolization was performed through a jailing technique as previously described 11. Alternative techniques such as the ‘remostent’ technique could not be employed as the LVIS Blue requires an 0.021 inch inner diameter microcatheter 12. Dual antiplatelet therapy was continued postoperatively until follow-up angiography was performed.…”

Section: Methodsmentioning

confidence: 99%

LVIS Blue as a low porosity stent and coil adjuvant

Koch

Stapleton

Raymond

et al. 2018

J NeuroIntervent Surg

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“…The development of low-profile stents is a further interesting evolution that permits to combine both BAC and SAC. 45 SAC was also precociously used as rescue approach in case of coil herniation or migration of coils into the parent vessel. Because stents are implanted in the parent artery, bridging the aneurysm neck, risk of implant thrombosis is higher than with coiling alone.…”

Section: Stent-assisted Coilingmentioning

confidence: 99%

Endovascular Treatment of Intracranial Aneurysms

Piérot

Wakhloo

2013

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2046I n a recent systematic review and meta-analysis, the overall prevalence of unruptured intracranial aneurysms (IAs) is estimated as 3.2%. 1 The prevalence of IAs is higher in patients with autosomal dominant polycystic kidney disease or a positive family history of IAs of subarachnoid hemorrhage (SAH).1 From the same review, the size of unruptured IAs is <5 mm in 66%, 5 to 9 mm in 27%, and ≥10 mm in 7%; the site of IAs is internal carotid artery, including posterior communicating artery in 42%, middle cerebral artery in 35%, and anterior cerebral artery and anterior communicating artery in 18%.Most IAs are clinically silent until rupture, which is unpredictable and sometimes associated with SAH, intraparenchymal hematoma, and an intraventricular hemorrhage. The case fatality of IA rupture is high (from 27% to 44%), but has decreased during the past 3 decades because of the introduction of improved management strategies, including neurocritical care.2 The International Study of Unruptured Intracranial Aneurysms (ISUIA) showed an increased risk of IA rupture with aneurysm size and for posterior circulation aneurysms. Although treatment of a ruptured aneurysm is accepted as an emergency, indication for treatment of unruptured IAs is still being discussed. Decision for treatment is based on clinical and anatomic factors; among them, the most important being patient's age, family history of IA(s), associated conditions (autosomal dominant polycystic kidney disease), symptomatic aneurysms, aneurysm size, and location. The randomized International Subarachnoid Aneurysm Trial (ISAT) study has clearly demonstrated the superiority of endovascular treatment (EVT) of ruptured aneurysms using coil technology over surgery. 4 Since the publication of these results, EVT has rapidly evolved. Although for unruptured aneurysms a direct comparison between EVT and surgery is not available, EVT has been widely used in this subgroup as well. 5In fact the population presenting with IAs is quite heterogeneous, regarding their status at presentation (ruptured versus unruptured), aneurysm shape (fusiform versus saccular) and location (aneurysm geometry in relationship to parent artery), their size (small/large/giant), the size of their neck (small/ large), and other factors. The heterogeneity illustrates that various approaches have to be considered to treat all types of IAs by EVT. During the past >2 decades, different therapeutic modalities were developed for EVT of IAs, and the goal of the present review is to describe them and to analyze their role in the management of IAs. CoilingEVT of IAs was introduced by use of detachable latex balloons and pushable coils. Because their use was cumbersome and associated with high incidence of periprocedural complications, they were applied in a relatively limited number of patients who were difficult to treat with standard surgery. The development of coils with controlled detachable system was clearly the first important step for widespread use of EVT. 6,7 Initial large series showed accepta...

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Combined use of a double-lumen remodeling balloon and a low-profile stent in the treatment of intracranial aneurysms (‘remostent’ technique): A technical note

Cited by 13 publications

References 3 publications

The next step in balloon assisted endovascular neurosurgical procedures: A case series of initial experience with the Scepter Mini balloon microcatheter

The next step in balloon assisted endovascular neurosurgical procedures: A case series of initial experience with the Scepter Mini balloon microcatheter

LVIS Blue as a low porosity stent and coil adjuvant

Endovascular Treatment of Intracranial Aneurysms

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