J Cerebrovasc Endovasc Neurosurg.  2023 Jun;25(2):175-181. 10.7461/jcen.2023.E2022.10.004.

Initial experience with Scepter Mini dual lumen balloon for embolization of cerebrovascular diseases

• Manzoor MU
• Almulhim IA
• Alrashed AA
• Althubait S
• Alturki AY
• Al-Qahtani SM

• KMID: 2543513
• DOI: http://doi.org/10.7461/jcen.2023.E2022.10.004

Abstract

Objective
Endovascular treatment of cerebrovascular diseases is often challenging due to small caliber, tortuous distal vessels. Several devices and techniques have evolved to overcome these challenges. Recently, a low profile dual lumen microballoon catheter, specifically designed for distal navigation is employed for neurovascular procedures. Due to its recent advent, scarce data is available on clinical utility and safety of Scepter Mini. The aim of this case series is to report our initial experience with Scepter Mini in the management of various cerebrovascular diseases.
Methods
All interventional neurovascular cases performed using Scepter Mini between January 2020 till April 2021 were included. Data regarding patient demographics, procedural details and complications was retrospectively collected from patient’s electronic medical record and procedure reports.
Results
Total twelve embolization procedures were performed in eleven patients, including six brain arteriovenous malformation, two dural arteriovenous fistula, one vein of Galen malformation and three hyper-vascular glomus tumor embolizations. All procedures were successfully performed with adequate penetration of the embolic agent. Complete embolization was performed in six procedures, while intended partial embolization was performed in the rest of procedures. Scepter Mini was solely used in ten procedures, however in the other two embolization procedures it was used as an additional conjunct tool to complete the intended embolization. No balloon related complication was observed in any procedure.
Conclusions
Scepter Mini dual lumen microballoon catheter is safe and feasible for delivery of liquid embolic agents for cerebrovascular embolization procedures.

Keyword

Scepter Mini; Micro-balloon; Dual lumen balloon; Embolization

Figure

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  Fig. 1. (A) Initial angiogram of the right external carotid artery demonstrates hypervascular glomus tumor with arterial feeders arising from ascending pharyngeal artery. (B) Inflated Scepter Mini balloon within the ascending pharyngeal artery. (C) Post embolization angiogram shows complete embolization of the tumor

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  Fig. 2. (A) Angiogram of the right middle cerebral artery demonstrates a posterior parietal AVM. (B) Roadmap image shows navigation of Scepter Mini balloon catheter into the arterial feeder. (C) Inflated Scepter Mini balloon catheter into the arterial feeder. (D) Selective angiogram through the Scepter Mini balloon outlining the compact AVM nidus. (E) Onyx cast matching the AVM nidus. (F) Post embolization angiogram demonstrates complete obliteration of the AVM with no residual filling of the nidus. AVM, arteriovenous malformation

Reference

1. Abecassis IJ, Nerva JD, Ghodke BV, Sekhar LN, Levitt MR, Kim LJ, et al. The dual microcatheter technique for transvenous embolization of dural arteriovenous fistulae. J Neurointerv Surg. 2017; Jun. 9(6):578–82.

2. Borota L, Mahmoud E, Nyberg C, Lewén A, Enblad P, Ronne-Engström E. Dual lumen balloon catheter - An effective substitute for two single lumen catheters in treatment of vascular targets with challenging anatomy. J Clin Neurosci. 2018; May. 51:91–9.

3. Case D, Folzenlogen Z, Rochon P, Kumpe D, Roark C, Seinfeld J. Embolization of head and neck vascular malformations using serial arterial embolization followed by dominant arterial embolization with two microcatheter technique. J Vasc Interv Neurol. 2018; Nov. 10(2):47–51.

4. Chapot R, Stracke P, Velasco A, Nordmeyer H, Heddier M, Stauder M, et al. The pressure cooker technique for the treatment of brain AVMs. J Neuroradiol. 2014; Mar. 41(1):87–91.

5. Flores BC, See AP, Weiner GM, Jankowitz BT, Ducruet AF, Albuquerque FC. Use of the Apollo detachable-tip microcatheter for endovascular embolization of arteriovenous malformations and arteriovenous fistulas. J Neurosurg. 2018; Mar. 130(3):963–71.

6. Gentric JC, Raymond J, Batista A, Salazkin I, Gevry G, Darsaut TE. Dual-lumen balloon catheters may improve liquid embolization of vascular malformations: an experimental study in swine. AJNR Am J Neuroradiol. 2015; May. 36(5):977–81.

7. Heit JJ, Faisal AGS, Telischak NA, Choudhri O, Do HM. Headway duo microcatheter for cerebral arteriovenous malformation embolization with n-BCA. J Neurointerv Surg. 2016; Nov. 8(11):1181–5.

8. Jagadeesan BD, Grigoryan M, Hassan AE, Grande AW, Tummala RP. Endovascular balloon-assisted embolization of intracranial and cervical arteriovenous malformations using dual-lumen coaxial balloon microcatheters and Onyx: initial experience. Neurosurgery. 2013; Dec. 73(2 Suppl Operative):ons238–43. discussion ons243.

9. 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; Apr. 27(2):298–306.

10. Orozco LD, Luzardo GD, Buciuc RF. Transarterial balloon assisted Onyx embolization of pericallosal arteriovenous malformations. J Neurointerv Surg. 2013; Jul. 5(4):e18.

11. Ozpar R, Nas OF, Hacikurt K, Taskapilioglu MO, Kocaeli H, Hakyemez B. Endovascular treatment of intracranial arteriovenous malformations using detachable-tip microcatheters and Onyx 18^®. Diagn Interv Imaging. 2019; Jun. 100(6):353–61.

12. Paramasivam S, Niimi Y, Fifi J, Berenstein A. Onyx embolization using dual-lumen balloon catheter: initial experience and technical note. J Neuroradiol. 2013; Oct. 40(4):294–302.

13. Spiotta AM, James RF, Lowe SR, Vargas J, Turk AS, Chaudry MI, et al. Balloon-augmented Onyx embolization of cerebral arteriovenous malformations using a dual-lumen balloon: a multicenter experience. J Neurointerv Surg. 2015; Oct. 7(10):721–7.

14. Spiotta AM, Miranpuri AS, Vargas J, Magarick J, Turner RD, Turk AS, et al. Balloon augmented Onyx embolization utilizing a dual lumen balloon catheter: utility in the treatment of a variety of head and neck lesions. J Neurointerv Surg. 2014; Sep. 6(7):547–55.

15. 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; Mar. 13(3):261–6.

16. Vollherbst DF, Otto R, Do TD, von Deimling A, Kauczor HU, Bendszus M, et al. Extra-small dual-lumen micro-balloon catheters can improve endovascular embolization: an experimental in vivo and in vitro study. J Neurointerv Surg. 2018; Nov. 10(11):1092–6.

17. Weber W, Kis B, Siekmann R, Kuehne D. Endovascular treatment of intracranial arteriovenous malformations with onyx: technical aspects. AJNR Am J Neuroradiol. 2007; Feb. 28(2):371–7.