Loop microcatheter technique for coil embolization of paraclinoid aneurysms

Jia, Zhen; Yun, Seok-Kweon; Sheen, Jae Jon; Kim, Joong-Goo; Lee, Chae Woon; Suh, Dae Chul

doi:10.1007/s00701-018-3642-5

Cited by 16 publications

(13 citation statements)

References 12 publications

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“…Our early first-in-human results highlight the ability of the Bendit21 to be navigated through complex vasculature without delays or vessel damage. The acute-angle branching in the internal carotid artery has presented a challenge for catheterization with conventional microcatheters 11 14 15. Likewise, the extradural (V3) curve of the vertebral artery is difficult to reproduce in microcatheters of a fixed shape 3.…”

Section: Discussionmentioning

confidence: 99%

Clinical experience with the Bendit steerable microcatheter: a new paradigm for endovascular treatment

Killer‐Oberpfalzer

Chapot

Orion

et al. 2022

J NeuroIntervent Surg

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BackgroundVessel tortuosity poses a challenge during endovascular treatment of neurovascular lesions. Bendit Technologies (Petah Tikva, Israel) has developed flexible, steerable microcatheters designed with unique bending and torquing capabilities.ObjectiveTo describe our first-in-human trial of Bendit21.MethodsBendit21 was used in our exploratory, prospective, multicenter, open-label, single-arm clinical study, and in two compassionate use cases. Procedures were conducted at four centers in Austria, Germany, Israel, and the United States between May 2021 and March 2022, in patients with neurovascular conditions. The primary endpoints were device-related safety events, successful navigation through the neurovasculature, and, when intended, successful delivery of contrast or therapy.ResultsTwo patients with giant aneurysms were treated successfully under compassionate use approval. The clinical study included 25 patients (mean age: 63.4±11.8 years; 32.0% female). Fourteen patients (56.0%) had aneurysms, two had arteriovenous malformations/fistulas (8.0%), one had a stroke (4.0%), four (16.0%) had intracranial stenosis, and four (16.0%) had other conditions. Bendit21 was used without a guidewire in 12/25 (48.0%) procedures. Bendit21 was successfully navigated through the vasculature without delays or spasms in all cases (100%). Contrast was delivered as intended in 7/7 (100%) cases. Therapeutic devices were delivered successfully with Bendit as intended in 14/18 (77.8%) cases; four deficiencies occurred in three patients with aneurysms, in whom delivery of coils, an intrasaccular device, or a flow diverter was attempted. There were no device-related safety events or mortalities.ConclusionsOur initial clinical experience with the Bendit21 microcatheter demonstrates its usefulness in achieving technical success in patients with challenging neurovascular conditions.

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Section: Discussionmentioning

confidence: 99%

Clinical experience with the Bendit steerable microcatheter: a new paradigm for endovascular treatment

Killer‐Oberpfalzer

Chapot

Orion

et al. 2022

J NeuroIntervent Surg

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“…Stabilization of the microcatheter loop via a partially inflated balloon We already described the loop microcatheter technique for paraclinoid aneurysms. 26 However, the loop technique alone can sometimes be unstable while the coils are introduced into the aneurysm. In this situation, we additionally supported the microcatheter loop using a balloon catheter (Scepter XC™; Microvention, Tustin, CA, USA) with a double-lumen for guidewire and ballooning.…”

Section: Ballooning Strategiesmentioning

confidence: 99%

Microcatheter Stabilization Technique Using Partially Inflated Balloon for Coil Embolization of Paraclinoid Aneurysms

et al. 2021

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Purpose: Coil embolization of paraclinoid aneurysms should be simple, safe, and effective considering the benign nature of the aneurysm. Here, we present a microcatheter stabilization technique using a partially inflated balloon for the treatment of paraclinoid aneurysms.Materials and Methods: This retrospective study included 58 patients who underwent balloon-assisted coiling (BAC) for unruptured paraclinoid aneurysms at a tertiary neuro-intervention center between January 2019 and March 2020. We applied a technique to stabilize the microcatheter’s position using the modified BAC technique in paraclinoid aneurysms showing various projections around the ophthalmic curve of the internal carotid artery. The basic concept of the technique is to place a partially inflated balloon just distal to the aneurysm neck and support the distal curve of the microcatheter using the proximal bottom of the balloon. Immediate radiological outcomes were analyzed, and clinical outcomes were evaluated with modified Rankin Scale (mRS) scores.Results: The BAC was successfully performed in 51 of 58 patients (88%). We treated the remaining seven patients by switching to stent-assisted coiling. We obtained a 37% mean packing density resulting in favorable occlusion in all 58 aneurysms (complete occlusion in 35 and residual neck in 23). There were no intraprocedural thromboembolic or hemorrhagic events except one that revealed an asymptomatic infarction after the procedure (1.7%). Magnetic resonance angiography follow-up was performed in 37 patients at an average of 11.8 months, in which 11 minor recurrences (29.7%) were found. There was no major recurrence nor retreatment. The mRS score was 0 in all patients during a mean follow-up of 17.7 months (range, 12–25 months).Conclusion: The modified balloon-assisted coiling technique using a partially inflated balloon was safe and effective and could serve as an option for treating paraclinoid aneurysms.

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“…[3][4][5] However, a 3D-printed blood vessel model is difficult to prepare in ruptured aneurysm cases and has limited use when readjustment of the shape of the microcatheter is needed. In addition, although microcatheter shaping is reportedly decided in advance according to the location of the aneurysm, [6][7][8] the shape, angle, and length of the microcatheter should be changed according to the individual conditions depending on the direction of the aneurysm axis the microcatheter (Fig. 4D).…”

Section: Casementioning

confidence: 99%

Microcatheter Re-Shaping Using Fusion Image in Coil Embolization: A Technical Note

Hirayama

Srivatanakul

Shigematsu

et al. 2021

JNET

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We report the utility of microcatheter reshaping by referring to fusion images with 3D-DSA and microcatheter 3D images made using non-subtraction and non-contrast (non-SC) rotational images. Case Presentations: Case 1: The patient was a 74-year-old man who had an internal carotid-anterior choroidal artery bifurcation aneurysm with a tortuous proximal parent artery. The initial attempt to introduce the microcatheter into the aneurysm was unsuccessful. During this unsuccessful microcatheter introduction, we created fusion images with 3D-DSA and microcatheter 3D images by acquiring positional information of the microcatheter using the non-SC method. By reshaping the microcatheter with reference to the fusion images, the direction of the distal end of the microcatheter was reshaped to be in accordance with the long axis of the aneurysm, a shape more suitable for coiling. Case 2: The patient was a 47-year-old man who had an anterior communicating (A-com) artery aneurysm with two daughter sacs. We successfully placed two microcatheters in the direction of each sac to make more stable framing by referring to 3D fusion images after the first microcatheter was positioned. In both cases, microcatheter reshaping was necessary because of the vessel and aneurysm anatomy. We have used this technique successfully in 15 patients, for both ruptured and unruptured aneurysms. The average number of microcatheter reshaping was 1.3 times. Conclusion: This method provides effective microcatheter reshaping for coil embolization of aneurysms, particularly those with differences between the axis of the parent artery and the vertical axis of aneurysm, or with a tortuous proximal artery. Keywords▶ microcatheter shaping, coil embolization, fusion image Case Presentation Materials This study investigated 15 aneurysms (8 ruptured aneurysms and 7 unruptured aneurysms) among 33 consecutive aneurysms embolized by a single operator (A.H.) from This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

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Loop microcatheter technique for coil embolization of paraclinoid aneurysms

Abstract: Loop microcatheter technique allowed safe and stable coil packing for paraclinoid aneurysms. The same procedural concept is also being used for aneurysms in other vascular territories.

Cited by 16 publications

References 12 publications

Clinical experience with the Bendit steerable microcatheter: a new paradigm for endovascular treatment

Clinical experience with the Bendit steerable microcatheter: a new paradigm for endovascular treatment

Microcatheter Stabilization Technique Using Partially Inflated Balloon for Coil Embolization of Paraclinoid Aneurysms

Microcatheter Re-Shaping Using Fusion Image in Coil Embolization: A Technical Note

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