MS-23 * IMPROVING FORWARD INFUSION PRESSURE IN VASCULAR BRAIN TUMORS USING A DOUBLE CATHETER AND COIL TECHNIQUE

Abstract

BACKGROUND: Intra-arterial infusion into vascular brain tumors can be difficult due to high intraluminal back pressures. We developed a double catheter and coil technique to improve forward penetration while minimizing backflow. METHODS: Patients undergoing preoperative embolization underwent angiographic evaluation of the tumor vascularity. The embolic agent N-Butyl-Cyanoacrylate (NBCA) was chosen to achieve obliteration of the vascular bed. An occlusive micro-catheter was placed at the orifice of the principal feeding artery. A second, coaxial, microcatheter was advanced into the tumor supply vessel. A coil was then deployed proximally through the first catheter to create a buttress for the NBCA and to effectively prevent any backflow of embolization agent. RESULTS: Backflow into the access vessel was prevented in all cases. Sufficient anterograde pressure gradients were maintained to achieve penetration of NBCA into the entire tumor. Post-procedural angiogram did not reveal any vessel truncations, distal embolization or residual tumor staining. CONCLUSIONS: Sufficient anterograde tumor penetration with NBCA can be achieved using a double catheter and proximal coil strategy. This technique may prove useful to infuse tumors with high viscosity therapeutics.