Scepter mini assisted angiographic cure of a Vein of Galen Malformation with n-butyl cyanoacrylate

Abstract

Background Even in the modern endovascular era, the treatment of Vein of Galen Malformations (VOGM) is extremely challenging. While their natural history is very poor, endovascular embolization has emerged as the standard of care. These lesions often require multiple treatment sessions to decrease shunting, with each treatment including multiple pedicles. Here we present the first reported use of the Scepter Mini (Microvention, Aliso Viejo, CA) in the treatment of vein of Galen malformations. Clinical presentation A 7 month old female presented with an enlarging VOGM that was initially identified on prenatal ultrasound. Given the enlarging size of the lesion and failure to meet developmental milestones, the patient underwent planned endovascular embolization of the VOGM. The novel Scepter Mini balloon catheter was used for treatment of this lesion affording easy access to the target pedicle and immediate flow arrest which allowed for immediate cure of the lesion. Conclusion The novel Scepter Mini Balloon (Microvention, Aliso Viejo, CA) afforded excellent distal access with subsequent immediate flow arrest therefore facilitating endovascular cure. Initially, a staged approach was favored for the treatment of the lesion, but the flow arrest achieved by the Scepter mini facilitated immediate occlusion from a single pedicle.

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

“…However, SMC is novel in that it has a smaller OD (Table 2) that can be navigated easily in small and tortuous distal vessels. 4–9 These characteristics reinforced the selection of the SMC for use in our cases compared with Scepter C and XC. Overall navigability of the SMC was scored as 2/5 by the interventionists who performed the cases (1: very easy, 2: easy, 3: intermediate, 4: difficult, 5: very difficult).…”

“…6 Multiple single-institution case series 5–9 and a multi-center study 4 have demonstrated SMC’s efficacy and safety profile, mainly in the adult population. Different techniques that have been proposed with SMC include LEA embolization of an AVM, 4 dAVF 7 or VOGM, 8 pure temporary flow control with the SMC and embolization with another microcatheter, 4 diagnostic angiography with concurrent flow control, 4 navigational support, 4 and support for positioning or repositioning of the Woven Endobridge (WEB) device. 6 The smallest so far reported vessel diameter catheterized with the SMC is 0.9 mm 4 and 0.8 mm 6 , 9 at the SMC tip.…”

“…The existing literature regarding SMCs is currently limited in short case series, 4–9 none of which are purely pediatric. Pediatric vascular anatomy makes navigation more difficult compared with the adult patient and narrow vessels necessitate smaller outer-diameter (OD) catheters.…”

“…Previous work has proven the use of DLBCs to be a safe and efficient technique. 2,[4][5][6][7][8][9] The importance of proximal balloon inflation during fistula embolization is twofold: it allows improved penetration of the LEA to the site of the fistula and also prevents LEA reflux into the normal vascular territory. 2,4 Dual-lumen balloon mounted catheters have been utilized for the last decade for these purposes.…”

“…10 Embolic agent reflux can cause entrapment of the catheter tip, untoward embolization of non-targeted arterial pedicles, or closure of arterial access, and balloon microcatheters have been shown to prevent these complications. 1,2,11 The existing literature regarding SMCs is currently limited in short case series, [4][5][6][7][8][9] none of which are purely pediatric. Pediatric vascular anatomy makes navigation more difficult compared with the adult patient and narrow vessels necessitate smaller outer-diameter (OD) catheters.…”