Neurointervention.  2019 Mar;14(1):27-34. 10.5469/neuroint.2018.01074.

Efficiency of Air Bubble Removal in Preparation of Low-Profile Angioplasty Balloon Catheter: Bench-Top Comparison of Six Methods

• Choi JH
• Hwang SM
• Lee DH

• KMID: 2446779
• DOI: http://doi.org/10.5469/neuroint.2018.01074

Abstract

PURPOSE
Complete removal of air bubbles from balloons for neurovascular angioplasty is cumbersome. We compared the preparation difficulty, air removal efficiency, and air collection pattern of six different balloon catheter preparation methods to propose a better preparation method for both initial and second balloon uses, especially for small-profile angioplasty balloon catheters. MATERIALS AND METHODS: A total of 18 neurovascular angioplasty balloon catheters with nominal diameters of 2 mm were prepared to test six different preparation methods: the instruction for use method (method A), simplified method using a syringe (method B) and four newly devised preparation methods using inflating devices (methods C-F). Serial radiographs were obtained while the balloons were gradually inflated. We measured the time for each preparation and the bubble number, analyzed their distribution in the balloon, and calculated the contrast filling ratio (contrast filling area/total balloon area) for initial and second ballooning. The whole process was repeated three times.
RESULTS
The preparation time varied widely (11.5 seconds [method D] to 73.3 seconds [method A]). On initial inflation, the contrast filling ratio at 8 atm was the highest (100%) with methods A and F. On second inflation, the ratio was again highest with method A (99.5%), followed by method F (99.2%). Initial ballooning tended to show a uniform pattern of single bubble in the distal segment of the balloon; in contrast, second ballooning showed varying patterns in which the bubbles were multiple and randomly distributed.
CONCLUSION
None of the six methods were able to completely exclude air bubbles from the balloon catheters including the second ballooning; however, the method of repeating aspiration with high-volume inflating device (method F) could be a practical option considering the simplicity and efficiency of preparation.

Keyword

Intracranial atherosclerosis; Balloon angioplasty; Air embolism; Device failure

MeSH Terms

Angioplasty*
Angioplasty, Balloon
Catheters*
Clothing
Embolism, Air
Equipment Failure
Inflation, Economic
Intracranial Arteriosclerosis
Methods*
Syringes

Figure

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  Fig. 1. Radiographs obtained during the initial ballooning. The six balloons were placed side-by-side from method A to method F (left to right). (A) After finishing preparation and right before the inflation at 0 atm, (B) 1 atm, (C) 2 atm, (D) 4 atm, (E) 6 atm, and (F) 8 atm, which was the nominal pressure of the balloon catheter.

• 

  Fig. 2. Radiographs obtained during the second ballooning. The six balloons were placed side-by-side from method A to method F (left to right). (A) After complete deflation and right before the second inflation at 0 atm, (B) 1 atm, (C) 2 atm, (D) 4 atm, (E) 6 atm, and (F) 8 atm. Compared with the initial ballooning, the balloons tend to show multiple air bubbles. Please note additional air bubbles as small defects at the proximal and distal tips of the inflating balloons.

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  Fig. 3. Contrast filling ratio of the initial ballooning. The best ratio was seen in methods A and method F, whose lines overlapped due to nearly similar values in all pressure points.

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  Fig. 4. Contrast filling ratio of second ballooning. The best ratio was seen in method A, followed by method F.

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  Fig. 5. Possible combination of an inflating device and a syringe for further improvement of preparation efficiency. After repeated aspirations with the inflating device, bubbles aspirated into the barrel of the device can be removed by the syringe using the stopcock.

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