Neurointervention.  2022 Jul;17(2):110-114. 10.5469/neuroint.2022.00171.

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

• Ioannidis I
• Adamou A
• Nasis N
• Vlychou M
• Poullos N

• KMID: 2531567
• DOI: http://doi.org/10.5469/neuroint.2022.00171

Abstract

The scope of this technical note is to report our experience with balloon remodeling for wideneck aneurysms and balloon angioplasty of post-subarachnoid hemorrhage vasospasm using the novel Scepter Mini balloon (SMB). Five cases were treated with balloon remodeling for aneurysmal subarachnoid hemorrhage, 2 of which were additionally treated with angioplasty due to post-bleeding vasospasm. All patients had their aneurysm located on parent vessels with a diameter smaller than 2 mm. Complete occlusion was noted in all aneurysms, and the patients had no short-term complications attributed to the catheterization. Additionally, we confirm the previously reported smooth navigation of the balloon through vessels with tortuous anatomy without catheter-induced vasospasm. Based on our experience, the SMB can be a safe and efficient device for applying the balloon remodeling technique for distally located wide-neck aneurysms and distal balloon angioplasty.

Keyword

Balloon embolization; Aneurysm; Intracranial vasospasm; Balloon angioplasty

Figure

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  Fig. 1. A 70-year-old female (case 2) presenting with aneurysmal SAH (Hunt and Hess grade IV) from rupture of a left wide-neck pericalossal aneurysm (A, white arrowhead). The patient was treated endovascularly with balloon remodeling with a Scepter Mini balloon (SMB) on the 8th post-bleed day. The balloon was successfully inflated at the origin of the calossomarginal artery. Sufficient aneurysm occlusion was obtained (B, black arrowhead). During embolization, continuous intra-arterial infusion of Nimodipine was used to reverse vasospasm of the ACA. Furthermore, balloon angioplasty was then performed with the SMB from A1 to A4 segments (C, white arrow). Navigation of the balloon in the distal segments was successfully done by using a 0.007- inch hybrid micro guidewire (Balt Extrusion, Montmorency, France). SAH, subarachnoid hemorrhage; ACA, anterior cerebral artery.

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  Fig. 2. A 56-year-old female (case 3) presented with aneurysmal SAH (Hunt and Hess grade V) and was treated on the 4th post-bleed day for a wide-neck aneurysm (A) of the left posterior inferior cerebellar artery (PICA). A Scepter Mini balloon (SMB) (B, white arrowheads) was used for the balloon remodeling technique due to the morphology of the aneurysm. Catheterization of PICA was performed from the contralateral VA. Navigation of the SMB through tortuous anatomy was achieved with no complication, and occlusion of the aneurysm was obtained (C, black arrowhead). SAH, subarachnoid hemorrhage; VA, vertebral artery.

Reference

1. Moret J, Cognard C, Weill A, Castaings L, Rey A. The «Remodelling technique» in the treatment of wide neck intracranial aneurysms. Angiographic results and clinical follow-up in 56 cases. Interv Neuroradiol. 1997; 3:21–35.

2. Pierot L, Cognard C, Spelle L, Moret J. Safety and efficacy of balloon remodeling technique during endovascular treatment of intracranial aneurysms: critical review of the literature. AJNR Am J Neuroradiol. 2012; 33:12–15.

3. Chaudhry NS, Orning JL, Shakur SF, Amin-Hanjani S, Aletich VA, Charbel FT, et al. Safety and efficacy of balloon angioplasty of the anterior cerebral artery for vasospasm treatment after subarachnoid hemorrhage. Interv Neuroradiol. 2017; 23:372–377.

4. Pulli B, Sussman ES, Mayercik V, Steinberg GK, Do HM, Heit JJ. Initial experience with the Scepter Mini dual-lumen balloon for transophthalmic artery embolization of anterior cranial fossa dural arteriovenous fistulae. J Neurointerv Surg. 2020; 12:1132–1136.

5. Vollherbst DF, Chapot R, Wallocha M, Saatci I, Cekirge S, Rouchaud A, et al. First clinical multicenter experience with the new Scepter Mini microballoon catheter. J Neurointerv Surg. 2021; 13:261–266.

6. Jagadeesan BD, Iv CQ, Masood K, Grande A, Tummala RP. Scepter-mini balloon assisted coil embolization of an intracranial arterial aneurysm in a child with PHACE syndrome via a persistent trigeminal artery. Neurointervention. 2021; 16:175–179.

7. Kim SH, Kim TG, Kong MH. Transarterial balloon-assisted onyx embolization of intracranial arteriovenous malformations using a dual-lumen balloon microcatheter: two case reports. J Cerebrovasc Endovasc Neurosurg. 2017; 19:223–230.

8. White TG, Shah KA, Turpin J, Dehdashti AR, Link T, Katz JM, et al. Single institution early clinical experience with the Scepter Mini balloon catheter. Neuroradiol J. 2021; 34:562–567.

9. Kular S, Tse G, Pahwa B, Goddard T, Saleem N, Nagaraja S, et al. Micro-balloon-assisted embolization of anterior cranial fossa dural arteriovenous fistula via a trans-ophthalmic approach - a technical report and case series. Neuroradiology. 2022; 64:1269–1274.

10. Matsoukas S, Bageac D, Yaeger K, Berenstein A, T Fifi J, Shigematsu T. Initial experience with the Scepter Mini catheter for the embolization of vascular malformations in the pediatric population. [published online ahead of print Oct 5, 2021]. Neuroradiol J. 2021.

11. Ioannidis I, Lalloo S, Corkill R, Kuker W, Byrne JV. Endovascular treatment of very small intracranial aneurysms. J Neurosurg. 2010; 112:551–556.

12. Pierot L, Spelle L, Leclerc X, Cognard C, Bonafé A, Moret J. Endovascular treatment of unruptured intracranial aneurysms: comparison of safety of remodeling technique and standard treatment with coils. Radiology. 2009; 251:846–855.

13. Mehta T, Hassan A, Masood K, Tekle W, Grande A, Tummala R, et al. The next step in balloon assisted endovascular neurosurgical procedures: a case series of initial experience with the Scepter Mini balloon microcatheter. Interv Neuroradiol. 2021; 27:298–306.

14. Santillan A, Knopman J, Zink W, Patsalides A, Gobin YP. Transluminal balloon angioplasty for symptomatic distal vasospasm refractory to medical therapy in patients with aneurysmal subarachnoid hemorrhage. Neurosurgery. 2011; 69:95–101. discussion 102.

15. Labeyrie MA, Gaugain S, Boulouis G, Zetchi A, Brami J, Saint-Maurice JP, et al. Distal balloon angioplasty of cerebral vasospasm decreases the risk of delayed cerebral infarction. AJNR Am J Neuroradiol. 2019; 40:1342–1348.