Balloon Microcatheter Research Articles

Efficacy of a microballoon catheter in transarterial chemoembolization of hepatocellular carcinoma using miriplatin, a lipophilic anticancer drug: Short-term results.

The goal of the study was to evaluate the efficacy and safety of balloon-occluded transarterial chemoembolization (B-TACE) of hepatocellular carcinoma (HCC) using miriplatin (a lipophilic anticancer drug) and gelatin particles. B-TACE was performed for 62 HCC nodules in 33 patients who could not be treated by surgical resection or radiofrequency ablation. All 33 patients had a history of transarterial chemoembolization (TACE) treatment prior to B-TACE. As a historical comparison, we investigated 40 nodules in 28 patients treated by TACE using a conventional microcatheter (C-TACE), miriplatin and gelatin particles. The therapeutic effect per tumor was compared between the groups based on the Response Evaluation Criteria in Cancer Study Group of Japan (RECICL) and side-effects were compared based on the Common Terminology Criteria for Adverse Events (ver. 4.0). The therapeutic efficacy after 4-12 weeks was evaluated in 59 nodules in the B-TACE group and in 37 nodules in the C-TACE group. Of these nodules, TE4 occurred in 29 (49.2%) in the B-TACE group and in 10 (27%) in the C-TACE group. Local efficacy was significantly higher in nodules treated by B-TACE than by C-TACE. The side-effects on hepatic function were similar in the two groups. Our results suggest that B-TACE with miriplatin is a useful treatment for hepatocellular carcinoma.

Transvenous sclerotherapy of a large symptomatic orbital venous varix using a microcatheter balloon and bleomycin

An orbital venous varix is rare and can present with diplopia, proptosis, or hemorrhage. Treatment can be challenging, especially if the varix is in a posterior location within the orbit,...

Diameter of main tumor feeding artery of a hepatocellular carcinoma: Measurement at the entry site into the nodule

To measure the diameter of the main tumor feeding artery (TFA) of a hepatocellular carcinoma (HCC) nodule at the entry site into the nodule. Fifty-seven HCC nodules in 43 patients were analyzed using a 3-D workstation and picture archiving system (PACS). TFA was defined as an artery connected to a HCC nodule on catheter-assisted multidetector computed tomography angiography (CAMDCTA). The entry site of the main TFA into the nodule was identified on CAMDCTA, and the corresponding portion was measured on digital angiography (DA) or digital subtracted angiography (DSA). The measuring scale of the PACS was calibrated using the platinum tip of microballoon catheters 0.68 mm in diameter. We investigated the relationship between diameters of the nodule and its main TFA. The diameters of the nodule and its main TFA ranged 7-63 mm (20.3 ± 12.7) and 0.12-1.79 mm (0.41 ± 0.32), respectively. Simple regression analysis revealed a relationship between diameters of the nodule and its main TFA (P < 0.0001). The diameter of the main TFA was less than 1 mm in 53 of 57 nodules (93.0%), and less than 0.5 mm in 42 (73.7%). The diameter of main TFA was thicker in the larger nodule. The size of commercially available porous gelatin particles (1 or 2 mm in diameter) seems too large for embolization of most of HCC nodules.

Preliminary findings of arterial embolization with balloon-occluded and flow-dependent histoacryl glue embolization in a swine model.

To evaluate the potential usefulness of the balloon-occluded histoacryl glue embolization (B-glue) technique. Both flow-dependent (no balloon occlusion) and B-glue techniques were used for 24 intercostal arteries of two female swine. N-butyl 2-cyanoacrylate (NBCA) was diluted with lipiodol to a 50 % solution, which was infused after occluding the arteries with microballoon catheters. The embolization range, fragmentation, reflux, adhesion, and glue particle attachment were compared between flow-dependent and B-glue techniques. The B-glue technique was performed in a controlled fashion resulting in successful arterial occlusion without fragmented migration of the injected glue cast. Reflux occurred less frequently with the B-glue technique and was significantly different (p = 0.039) [Corrected] from that for the flow-dependent technique. Catheters were safely removed from the arterial walls, although in one instance (8.3 %), large glue particles were found to be attached to the catheter tip on removal. Conversely, the flow-dependent technique was more difficult to control and resulted in several instances of higher rates of fragmentation. The B-glue technique can efficiently control NBCA delivery with lower rates of reflux.

Superselective Coaxial Microballoon-Occluded Coil Embolization for Vascular Disorders: A Preliminary Report

PurposeTo evaluate the safety and effectiveness of superselective coil embolization with coaxial microballoon occlusion (B-coiling) for vascular disorders. Materials and MethodsClinical data were retrospectively evaluated for 16 consecutive patients (6 men, 10 women; mean age, 70 y; age range, 57–80 y) with vascular disorders who underwent B-coiling with 0.010–0.014-inch detachable microcoils delivered through a guide-wire lumen of a microballoon catheter. Routine angiographic catheters (4–5 F) were introduced in all cases, including splenic (n = 4) and renal (n = 3) artery aneurysms, pulmonary and renal arteriovenous malformations (AVMs; n = 3 and n = 1, respectively), gastroesophageal varices (GEVs; n = 3), gastroduodenal artery stump pseudoaneurysm (n = 1), and superficial temporal artery aneurysm (n = 1). ResultsComplete primary occlusion was achieved in 87.5% of cases (n = 14) without complications. Additional percutaneous transhepatic sclerotherapy by N-butyl cyanoacrylate (NBCA)/iodized oil mixtures without balloon occlusion resulted in successful occlusion of one GEV. Additional balloon-occluded NBCA injection was successfully performed in one renal AVM. ConclusionsSuperselective coaxial microballoon embolization with detachable microcoils is a safe and useful treatment. Selective B-coiling induces tight packing under flow control in the treatment of vascular disorders.

Balloon-Occluded Transarterial Chemoembolization for Peritoneal Metastasis of Hepatocellular Carcinoma

We report unusual 2 cases treated with Balloon-occluded transarterial chemoembolization (B-TACE) for peritoneal hepatocellular carcinoma (HCC) metastasis. An 87-year-old female with hepatitis-C related cirrhosis underwent radiofrequency ablation (RFA) repeatedly. Computed tomography showed a 30 mm diameter tumor seeding adjacent to the ascending colon. Digital subtraction angiography (DSA) of the gastroduodenal artery showed a tumor stain fed by an omental arterial branch distributing from the greater curvature of the stomach. Since ultraselective cannulation was difficult, a micro-balloon catheter was selected and advanced to the right gastroepiploic artery on the central side of the omental artery, and B-TACE was performed at this point. A 78-yearold male with hepatitis-C related cirrhosis underwent RFA and TACE repeatedly, but multiple HCC developed and a 45 mm diameter metastatic tumor adjacent to the descending colon was observed. DSA of the inferior mesenteric artery showed a tumor stain fed by the several peripheral branches of the left colic artery. Since one of this several branches was noted the normal mesenteric blood vessel by selective angiography, the position of the tip of the micro-balloon catheter was finely adjusted by balloon inflation to prevent inflow of the contrast medium into the normal blood vessel, and then B-TACE was performed.

Balloon-occluded transarterial chemoembolization using a 1.8-French tip Coaxial microballoon catheter for hepatocellular carcinoma: Technical and safety considerations

Objective: To evaluate the technical feasibility and safety considerations of balloon-occluded transarterial chemoembolization (B-TACE) using a newly developed 1.8-French (Fr) tip microballoon catheter for hepatocellular carcinoma (HCC). Material and methods: Between February 2013 and May 2013, 31 patients (20 males, 11 females; age range 56–85 years) underwent B-TACE using a 1.8-Fr tip microballoon catheter for unresectable HCC. The technical success rate, procedural complications, and adverse events of B-TACE were retrospectively investigated. Results: A total of 31 patients were subjected to 70 sessions of B-TACE using a 1.8-Fr tip microballoon catheter. The level of B-TACE was sub-subsegmental in 11, subsegmental in 35, segmental in 14, lobar in five, and right inferior phrenic artery in five sessions. The overall technical success rate was 99% (69 out of 70 sessions). As procedural complications, rupturing of the microballoon (n = 3) and aneurysmal dilatation at the site of balloon occlusion (n = 2) were encountered. There were no significant differences in any parameters between blood biochemical examination before and between two to four weeks after the procedure. Conclusion: A 1.8-Fr tip microballoon catheter enables selective catheterization in patients with HCC and B-TACE using the 1.8-Fr tip microballoon catheter is a safe procedure.

Safety and efficacy of balloon-occluded transcatheter arterial chemoembolization using miriplatin for hepatocellular carcinoma.

Balloon-occluded transcatheter arterial chemoembolization (B-TACE) using a microballoon catheter was performed to administrate miriplatin, and the early therapeutic efficacy and safety of the procedure were evaluated. Out of 158 patients who received miriplatin using B-TACE for hepatocellular carcinoma, 49 patients with a single lesion at either stage I or II (according to the Liver Cancer Study Group of Japan) were evaluated in comparison with 48 matched patients who received miriplatin using conventional TACE (C-TACE). The mean total dose and median dose of miriplatin in each group were 32.5 ± 31.7 mg and 20 mg (C-TACE) and 50.1 ± 31.3 mg and 40 mg (B-TACE), respectively (P < 0.01). The treatment effect (TE) on the target nodule classified as TE4, TE3, TE2 or TE1 was 39.6%, 33.3%, 25.0% and 2.1%, respectively, in the C-TACE group, and 55.1%, 38.8%, 4.1% and 2.0%, respectively, in the B-TACE group. Therefore, the TE was significantly higher in the B-TACE group (P < 0.05). Although abdominal blood tests revealed adverse, increased levels of serum alanine aminotransferase (ALT) in a significantly higher number of B-TACE-treated patients, serum ALT levels returned to baseline levels in all patients within 1 month. There were no significant differences in clinical symptoms between the two groups. Compared with C-TACE, B-TACE significantly improved cancer nodule control, and it was satisfactory in terms of safety. B-TACE is an effective procedure that enhances the effects of catheterization with miriplatin.

E-067 Balloon assisted Pre-operative Embolization of Hypervascular Metastatic Lesions to the Spine

IntroductionIt is common to perform pre-operative embolization of metastatic lesions to the spine from hyper-vascular tumors. Typically, a microcatheter is navigated into a prominent arterial feeder to the tumor arising...

E-068 Dual Lumen Balloon Assisted Pre-operative Embolization With Onyx for Hypervascular Head and Neck Tumors

IntroductionPre-operative embolization of hypervascular head and neck tumors can be achieved using particulate agents or liquid embolic agents. Particulate agents are preferable due to the lower cost. However, the presence...

E-073 Endovascular Treatment of a Traumatic Middle Meningeal Artery Pseudoaneurysm with Onyx LES: A Case Report and Review of Literature

BackgroundMiddle meningeal artery (MMA) pseudoaneurysms are very rare and are most often traumatic. They may present as an epidural or intraparenchymal hematoma (IPH). Very few cases in medical literature exist...

O-036 Treatment of Intracranial Aneurysms with the LUNA AES: Midterm Clinical and Angiographic Follow-Up

PurposeThe LUNA is a self-expanding ovoid device that serves as an intra saccular flow diverter as well as a scaffold for endothelization across the neck. The objective of this prospective...

E-052 Initial Institutional Experience with the Sceptre XC Balloon for the Endovascular Treatment of Cerebral Aneurysms

Background and purposeThe Sceptre XC balloon is a novel extra-compliant dual-lumen balloon microcatheter designed for the endovascular treatment of cerebral aneurysms and arteriovenous malformations. This study aims to describe our...

Endovascular Balloon-Assisted Embolization of High-Flow Peripheral Vascular Lesions Using Dual-Lumen Coaxial Balloon Microcatheter and Onyx: Initial Experience

Balloon-assisted embolization performed by delivering Onyx ethylene vinyl alcohol copolymer through a dual-lumen coaxial balloon microcatheter is a new technique for the management of peripheral vascular lesions. This technique does not require an initial reflux of Onyx to form around the tip of the microcatheter before antegrade flow of Onyx can commence. In a series of four patients who were treated with the use of this technique, the absence of significant reflux of Onyx was noted, as were excellent navigability and easy retrieval of the balloon microcatheter. However, in one patient, there was inadvertent adverse embolization of a digital artery, which was not caused by reflux of Onyx but could still be related to balloon inflation.

Abstract 125: Treatment of Intracranial Aneurysms With the LUNA AES Updated

Purpose: The LUNA Aneurysm Embolization System (AES) is a new self-expanding ovoid device that serves as an intra saccular flow diverter as well as a scaffold for endothelization across the neck. The objective of this prospective clinical study aiming to include a total of 63 patients was to evaluate the ability of the AES to occlude intracranial aneurysms while maintaining patency of the parent artery. Materials and Methods: Immediate post-implantation occlusion grade (complete (complete obliteration of the aneurysm including the neck), near-complete (persistence of any portion of the original defect of the arterial wall), or incomplete (any opacification of the sac) compared to baseline), and parent vessel compromise were evaluated. Patients underwent neurological testing with the Modified Rankin Scale and the National Institute of Health Stroke Scale (NIHSS) at baseline and time of discharge. Follow-up included clinical assessment at one, 3, 6, 9 and 12 months, and angiographic follow-up at 6 and 12 months. Results: 50 patients (9 men) with 47 unruptured and 4 ruptured saccular aneurysms (38 bifurcation, 13 sidewall, sizes from 3.9 to 10.1 mm) were enrolled to date in the study. In all but 2 aneurysms (2 failed procedure converted in coiling) 1 LUNA AES was deployed per aneurysm. In 5 cases, the LUNA AES placement was carried out with balloon microcatheter assistance. In one case, the LUNA AES placement was carried out with a stent. Clinical follow up was uneventful in all but 2 patients (one sustained SAH from a contralateral MCA aneurysm, one had GI bleeding). Immediate complete/near complete occlusion was obtained in 26.5% (13/49). At 6 month follow-up, complete/near complete occlusion was obtained in 70.8% (34/48). There was no parent artery occlusion. None of the treated aneurysm (re)bled during follow-up. 4 aneurysms treated with the LUNA needed retreatment (2 incomplete deployment of the LUNA into the sac, 2 angiographic recurrences). Conclusion: Preliminary results demonstrate good safety profile. Angiographic follow up are promising.

Balloon‐occluded retrograde transvenous obliteration using a microballoon catheter for intractable gastric fundal varices

Balloon-occluded retrograde transvenous obliteration (B-RTO) is recognized as the standard therapy for patients with gastric fundal varices in Japan; however, the procedure is difficult when drainage veins other than the gastrorenal shunt developed. The efficacy and safety of B-RTO using a microballoon catheter for such patients were evaluated. The subjects were 99 patients with gastric fundal varices who fulfilled the criteria for receiving endoscopic and/or interventional therapies. Among these, 95 patients underwent B-RTO. Of the 95 patients, 14 were treated with the use of microballoon catheters, including nine in whom the left inferior phrenic vein was found as a secondary drainage vein in addition to the gastrorenal shunt, and five in whom a gastrorenal shunt was absent. The B-RTO procedure performed using a microballoon catheter inserted through the left inferior phrenic vein in 13 patients, and through the pericardiophrenic vein in one patient. The B-RTO procedure using microballoon catheters was successful in 13 of the 14 patients (93%), while in the remaining one patient, multiple drainage veins were visualized on venography. Complete obliteration of the varices was achieved in all the 13 patients by injection of 5% ethanolamine oleate iopamidol at a median volume of 25 mL (range, 11 to 40 mL) through the catheters. None of the patients showed injuries of the drainage veins or any systemic complications. B-RTO using a microballoon catheter is useful for the treatment of gastric fundal varices in which drainage veins other than the gastrorenal shunt developed.

Endovascular treatment of dural arteriovenous fistulas using dual lumen balloon microcatheter: Technical aspects and results

ObjectiveWe report our results of our experience using transarterial balloon-assisted embolization of aggressive DAVFs using a dual lumen balloon microcatheter. The advantages and disadvantages of this technique when compared to different Onyx embolization techniques are discussed. Patients and methodsAll patients with aggressive DAVFs who were treated with Onyx using transarterial balloon-assisted technique with a dual lumen balloon microcatheter were included. Clinical presentation, location of DAVF, Borden type, dual lumen balloon microcatheter used, amount of Onyx used, Onyx injection duration, complications, immediate angiographic and follow up results were included in the analysis. ResultsFive patients fulfilled the selection criteria. Their ages ranged from 24 to 62 years old. In 4 cases the dual lumen balloon microcatheter was a Scepter-C 4mm×10mm (Microvention, Tustin, CA); in the other patient the device used was an Ascent 4mm×10mm (Codman, Raynham, MA). In all 5 patients the dual lumen balloon microcatheter was used with the objective to cure the lesion and it was successful in all 5 cases. There was no vessel injury, unwanted embolization, retained microcather, microcatheter rupture or cranial nerve deficits in our series. Our mean Onyx injection time was 6.4min (range from 2 to 10min). There were no procedural complications in our series. Four out of 5 patients had angiographic follow up demonstrating persistent angiographic cure (follow up mean 6 months – range 4–7 months). ConclusionsOur experience in this small series of patients indicates that the use of dual lumen balloon microcatheters is safe and feasible, facilitating the use of Onyx for embolization of DAVFs.

Stent, balloon-assisted coiling and double microcatheter for treating wide-neck aneurysms in anterior cerebral circulation

Objective:To investigate the clinical application of adjuvant coiling techniques in treating anterior-circulation wide-necked aneurysms.Methods:Over 4·5 years, 93 anterior-circulation wide-neck aneurysms in 81 patients were treated with different endovascular techniques: balloon-assisted, stent-assisted, and double-microcatheter coiling. Demographic, clinical, and angiographic data were reviewed retrospectively.Results:Of the 93 aneurysms, 45 were treated using stent, 28 using balloon, and 20 using double microcatheter. The proportion of ruptured aneurysms was significantly lower in the stent group (53·3%) than in the balloon (71·4%) or the double-microcatheter group (75%). Stent embolization was used for 61·1% of aneurysms located in the internal carotid artery, whereas aneurysms in the anterior communicating and middle cerebral arteries were mainly treated with balloon remodeling (42·9%) and double microcatheter (52·4%). The majority of aneurysms with neck ≧ 7 mm (87·5%) and all aneurysms with a dome/neck ratio < 1·0 (100%) were treated by stent-assisted coiling. For aneurysms with neck < 4 mm, the mean dome/neck ratio was 0·93 in the stent group, 1·08 in the balloon group, and 1·16 in the double-microcatheter group. Total occlusion was achieved in 21 cases (46·7%), with the rates for stent being significantly lower than for balloon (78·6%) or double microcatheter (75·0%). Clinical outcome was favorable in 73 cases (Glasgow Outcome Scale (GOS) 4–5) and fair in 4 (GOS 3), while 2 were severely disabled (GOS 2) and 2 others died (GOS 1).Conclusion:Double microcatheter was better for distal aneurysms with dome/neck ratio of 1·1–1·2, while stent was better for proximal aneurysms with an extremely wide neck (≧ 7 mm) and for loudspeaker-shaped aneurysms (dome/neck ratio < 1·0) with poor vessel condition. For emergency cases, both balloon remodeling and double microcatheter are better choices than stent.

Modified balloon assisted coil embolization for the treatment of intracranial and cervical arterial aneurysms using coaxial dual lumen balloon microcatheters: initial experience

IntroductionTraditional balloon assisted coil embolization techniques for intracranial aneurysms require a single lumen balloon to remodel the aneurysm neck and a separate microcatheter to place coils. Here we report utilization...

E-077 Aneurysm coiling with balloon remodelling of the neck of the aneurysm using a single co-axial dual lumen balloon micro catheter : Initial Experience

IntroductionCoil embolisation of intracranial aneurysms with the help of balloon remodelling of the aneurysm neck is a well-established technique for the treatment of wide necked intra-cranial aneurysms. This requires the...