Korean J Radiol.  2013 Oct;14(5):832-840. 10.3348/kjr.2013.14.5.832.

Initial Experience with the New Double-lumen Scepter Balloon Catheter for Treatment of Wide-necked Aneurysms

• Rho MH
• Kim BM
• Suh SH
• Kim DJ
• Kim DI

• KMID: 1711443
• DOI: http://doi.org/10.3348/kjr.2013.14.5.832

Abstract

OBJECTIVE
A new double-lumen balloon catheter was being developed for the treatment of cerebral aneurysms. The purpose of this study is to report our initial experience of a double-lumen balloon catheter for the treatment of wide-necked aneurysms.
MATERIALS AND METHODS
Seventeen patients (mean age, 63 years; range, 45-80 years) with wide-necked, with or without a branch-incorporated aneurysms, (10 ruptured and 9 unruptured) were treated with balloon-assisted coil embolization using a double-lumen balloon catheter (Scepter C(TM) or Scepter XC(TM)) for 7 months after being introduced to our country. Locations of the aneurysms were posterior communicating artery (n = 7), anterior communicating artery or A2 (n = 7), middle cerebral artery (MCA) bifurcation (n = 3), basilar artery tip (n = 1) and anterior choroidal artery (n = 1). The initial clinical and angiographic outcomes were retrospectively evaluated.
RESULTS
Coil embolization was successfully completed in all 19 aneurysms, resulting in complete occlusions (n = 18) or residual neck (n = 1). In one procedure, a thrombus formation was detected at the neck portion of the ruptured MCA bifurcation aneurysm near to the end of the procedure. It was completely resolved with an intra-arterial infusion of Glycoprotein IIb/IIIa inhibitor (Tirofiban, 1.0 mg) without any clinical sequela. There were no treatment-related events in the remaining 18 aneurysms. At discharge, functional neurological state improved in 11 patients (10 patients with ruptured aneurysm and 1 with unruptured aneurysm presenting with mass symptoms) and 6 patients with unruptured aneurysms had no newly developed symptoms.
CONCLUSION
In this preliminary case series, the newly developed double-lumen Scepter balloon appears to be a safe and convenient device for coil embolization of wide-necked aneurysms.

Keyword

Intracranial aneurysm; Coil embolization; Balloon

MeSH Terms

Aged
Aged, 80 and over
Aneurysm, Ruptured/diagnosis/*therapy
Balloon Occlusion/*instrumentation
*Catheters
Cerebral Angiography
Equipment Design
Female
Humans
Intracranial Aneurysm/diagnosis/*therapy
Male
Middle Aged
Retrospective Studies
Stents
Treatment Outcome

Figure

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  Fig. 1 Case 1. 72-year-old man with ruptured anterior communicating artery aneurysm.A. Advancement of Scepter balloon catheter over 0.014-inch microguidewire that was prepositioned at anterior cerebral artery A1 portion. B. Scepter balloon-assisted coil embolization performed after removal of microguidewire. C. Coil tail (white arrowhead) protruded after balloon deflation. D, E. Scepter balloon catheter is repositioned from right A2 to left A2 using microguidewire and is used to push coil tail in sac. F. Final control angiogram shows complete occlusion of aneurysm sac without any coil loop protrusion. Note that white arrow indicates distal tip marker of Scepter balloon catheter and black arrows indicate proximal and distal markers of balloon itself.

• 

  Fig. 2 Case 2. 66-year-old woman with ruptured aneurysm at middle left cerebral artery.A. Three-dimension reconstruction angiogram reveals large aneurysm at middle left cerebral artery bifurcation. Note that superior branch is incorporated into sac. B. After placement of balloon across aneurysm neck, gradual over-inflation causes substantial portion of balloon to herniate into aneurysm sac. C. At end of procedure, small thrombus (black arrowhead) is detected at aneurysm neck, close to origin of superior branch. D. After intraarterial infusion of Glycoprotein inhibitor, 30-minutes follow-up angiogram shows resolution of thrombus and complete occlusion of aneurysm sac. Note that white arrow indicates distal tip marker of Scepter balloon catheter and black arrows indicate proximal and distal markers of balloon itself.

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  Fig. 3 Case 3. 80-year-old woman with ruptured middle left cerebral artery aneurysms.A. Three-dimensional reconstruction angiogram reveals large aneurysm at middle left cerebral artery bifurcation and another very small aneurysm (white arrowhead) close to aneurysm neck at superior branch. B. After positioning Scepter balloon catheter across aneurysm neck, gradual over-inflation leads to herniation of central portion of balloon into large aneurysm sac. C. After balloon-assisted coil embolization of both aneurysms, final control angiogram shows complete occlusion of both aneurysms and well-preserved superior and inferior divisions. Black arrows indicate proximal and distal balloon markers of Scepter balloon catheter. White arrow indicated distal tip marker of Scepter balloon catheter (black arrows, proximal and distal balloon markers; white arrow, tip marker of balloon catheter).

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