Initial experience with the Scepter Mini catheter for the embolization of vascular malformations in the pediatric population

Abstract

Background Achieving distal access and flow control are of significant importance for the treatment of intracerebral arteriovenous shunting lesions. The Scepter Mini catheter is a low-profile, dual-lumen balloon catheter, designed to provide navigability in small-caliber, tortuous intracranial vessels. Objective To describe the initial experience of the Scepter Mini catheter in the treatment of pediatric arteriovenous malformations and fistulas. Methods A single-institution, retrospective chart review identified all consecutive uses of the Scepter Mini catheter for endovascular embolization of vascular malformations in the pediatric population. Results Three different arterial pedicles were embolized with the Scepter Mini catheter in two different patients. One patient was diagnosed with a vein of Galen malformation that had undergone multiple treatments and the other with a torcular dural arteriovenous fistula. All cases encompassed quite challenging tortuosity of small-caliber feeders which prevented the use of another microcatheter. The Scepter Mini catheter navigated into feeding arteries of diameters 0.65, 1.9, and 1.25 mm, and its balloon was inflated to achieve excellent blood flow control. Total obliteration (100%) of the shunting lesion was achieved in both cases. No reflux, pedicle rupture or other untoward effects were observed. Both patients had an uneventful recovery. Conclusion The Scepter Mini catheter afforded fast and safe distal access, flow control, and treatment of arteriovenous malformations in this initial pediatric cohort. The catheter’s low profile and easy navigability should support its use in tortuous and small arterial feeders, especially in the pediatric population.

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

“…8,9 A study also supports its use for distal AVF in tortuous and small arterial feeders, especially in the pediatric population, where vessel diameters may be as small as 0.65 mm. 10 The versatility of the catheter and its different applications are also reported in another study, indicating 4 distinct uses: AVF embolization, balloon-occlusion with simultaneous embolization via a second microcatheter, diagnostic angiography with simultaneous balloon obstruction for flow control, and navigation support. 5 The SMB was used in balloon-assisted coiling of distal intra-cranial aneurysms due to the small diameter or when there was an acute angulation of the parent artery.…”

“…In the first case, the available literature suggests that the catheters perform well with a high degree of technical success [ 8 , 9 ]. A study also supports its use for distal AVF in tortuous and small arterial feeders, especially in the pediatric population, where vessel diameters may be as small as 0.65 mm [ 10 ]. The versatility of the catheter and its different applications are also reported in another study, indicating 4 distinct uses: AVF embolization, balloon-occlusion with simultaneous embolization via a second microcatheter, diagnostic angiography with simultaneous balloon obstruction for flow control, and navigation support [ 5 ].…”

Giant Pediatric Dural Arteriovenous Fistula Management Using a Combined Operative Approach in a Hybrid Neuroendovascular Surgery Suite: Technical Nuances and Review of Literature

“…1 DSA is the current gold standard for diagnosis, and management of pediatric dAVFs is challenging given their complex clinical manifestations, anatomy and angioarchitecture, age, and high morbidity and mortality associated with rupture. [3][4][5] Early treatment of high-flow lesions is preferred for symptomatic patients to prevent further developmental delay and neurological sequelae from rupture. 12 Treatment modalities include endovascular embolization through a transarterial or transvenous route and open surgical disconnection.…”

“…Despite current treatment modalities and recent advances in endovascular technologies, achieving complete fistula obliteration remains challenging and shunt obliteration is seen in <50% of patients. 1,4,5 In rare instances, a hybrid approach with direct puncture of the venous sinus for endovascular access after surgical exposure has been reported. 4 Extensive literature review discovered 2 other cases in which direct puncture of the cerebral venous sinus was performed for endovascular access after surgical exposure in the pediatric population (Table 2).…”

“…12 Other reported techniques include coil embolization particle embolic agents, absolute ethanol, balloon occlusion, and silk sutures. 5,7,10,11 Open surgical disconnection is often reserved for cases that have failed multiple endovascular approaches. Despite current treatment modalities and recent advances in endovascular technologies, achieving complete fistula obliteration remains challenging and shunt obliteration is seen in <50% of patients.…”