Coaxial Balloon Research Articles

3:18 PM Abstract No. 103 Balloon-assisted Onyx embolization of high-flow peripheral arteriovenous malformations with dual-lumen coaxial balloon microcatheter: technical aspects and clinical results

The aim of this study was to demonstrate our experience in balloon-assisted Onyx (ethylene vinyl alcohol copolymer) embolization of high-flow peripheral arteriovenous malformations (AVMs) using dual-lumen coaxial balloon microcatheter technique, which does not necessitate a plug formation around the catheter that is required to allow antegrade flow of Onyx while preventing reflux and non-target embolization. This study expands the technique with its utilization on types of AVMs not described previously. Three patients with peripheral high-flow AVMs treated with balloon-assisted Onyx embolization using dual-lumen coaxial balloon microcatheter were retrospectively analyzed. AVMs were located in the kidney, pelvis, and chest wall. One patient required two sessions of Onyx embolization treatment. A total of 4 sessions were performed with Onyx 18 and/or Onyx 34 using Scepter XC occlusion balloon catheter. Imaging and clinical follow-ups were performed for all patients. Technical success was achieved in all patients. Complete devascularization was obtained in two patients with renal and pelvic AVMs with one treatment, while the patient with chest wall AVM required two sessions, which resulted in complete devascularization. There was no evidence of excessive reflux of Onyx or entrapment of the microcatheter. Non-target Onyx embolization or microcatheter fracture was not observed. After the final treatment, all patients were free of symptoms on clinical follow-up, and there was no evidence of recurrence identified on follow-up imaging. From our single-institutional experience, the technique using dual-lumen coaxial balloon microcatheter for balloon-assisted Onyx embolization appears to be safe and effective in treating high-flow peripheral AVMs, while allowing more precise injection of Onyx with the capability to reduce the risks associated with reflux of Onyx.

Two cases of retrograde dual balloon-occluded embolotherapy using coaxial double balloon catheter system

Two cases of retrograde dual balloon-occluded embolotherapy using coaxial double balloon catheter system

Balloon-assisted coil embolization and large stent delivery for cerebral aneurysms with a new generation of dual lumen balloons (Copernic 2L)

IntroductionDual coaxial lumen balloon microcatheters through which small stents can be delivered have recently been described. We report a series of a new type of dual lumen balloon catheter with...

Percutaneous radiologic gastrostomy catheter placement without gastropexy: a co-axial balloon technique and evaluation of safety and efficacy.

The purpose of this study is to evaluate the short-term safety and efficacy of a co-axial angioplasty balloon technique for percutaneous radiologic gastrostomy catheter placement (PRG). A total of 65 percutaneous radiologic gastrostomy tube placements were performed with the co-axial angioplasty balloon technique from 10/1999 to 1/2014. This included 19 females and 46 males between the ages of 20-83. Without the use of T-fasteners for gastropexy, the gastrostomy tube was placed over a catheter-shaft angioplasty balloon as a co-axial system. The angioplasty balloon was used to sequentially approximate the stomach wall to the abdominal wall, dilate the tract, and was then used as a dilator to aid gastrostomy tube advancement into the gastric lumen. Technical success, complications, and dislodgements were evaluated by means of retrospective review of patient medical records and imaging. There was no procedural failure in any of the 65 placements. 30-day follow-up was available for 56 patients. 7 patients died within 30 days; none of the deaths were recorded as procedure-related. There was 1 major complication (1.5%) consisting of a colocutaneous fistula. There were 4 minor complications (6.2%). There was no occurrence of bleeding or skin infection while using this technique. PRG with the co-axial angioplasty-balloon technique is a safe and effective technique for gastrostomy placement.

Comparative Analysis of Methods to Induce Myocardial Infarction in a Closed-Chest Rabbit Model.

Objective. To develop a rabbit model of closed-chest catheter-induced myocardial infarction. Background. Limitations of rodent and large animal models justify the search for clinically relevant alternatives. Methods. Microcatheterization of the heart was performed in 47 anesthetized 3-4 kg New Zealand rabbits to test five techniques of myocardial ischemia: free coils (n = 4), interlocking coils (n = 4), thrombogenic gelatin sponge (n = 4), balloon occlusion (n = 4), and alcohol injection (n = 8). In order to limit ventricular fibrillation, an antiarrhythmic protocol was implemented, with beta-blockers/amiodarone before and xylocaine infusion during the procedure. Clinical, angiographic, and echographic data were gathered. End points included demonstration of vessel occlusion (TIMI flow grades 0 and 1 on the angiogram), impairment of left ventricular function at 2 weeks after procedure (by echocardiography), and pathologically confirmed myocardial infarction. Results. The best arterial access was determined to be through the right carotid artery. The internal mammary guiding catheter 4-Fr was selected as the optimal device for selective intracoronary injection. Free coils deployed prematurely and tended to prolapse into the aorta. Interlocking coils did not deploy completely and failed to provide reliable results. Gelatin sponge was difficult to handle, adhered to the catheter, and could not be clearly visualized by fluoroscopy. Balloon occlusion yielded inconsistent results. Alcohol injection was the most efficient and reproducible method for inducing myocardial infarction (4 out of 6 animals), the extent of which could be fine-tuned by using a coaxial balloon catheter as a microcatheter (0.52 mm) to achieve a superselective injection of 0.2 mL of alcohol. This approach resulted in a 20% decrease in LVEF and infarcted myocardium was confirmed histologically. Conclusions. By following a stepwise approach, a minimally invasive, effective, and reproducible rabbit model of catheter-induced myocardial infarction has been developed which addresses the limitations of rodent experiments while avoiding the logistical and cost issues associated with large animal models.

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.

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...

E-061 Onyx Embolisation Through the Scepter Dual-Lumen System: Mechanisms and Utility

IntroductionEthyl Vinyl Alcohol co-polymer Onyx (ev3 Inc., Irvine, CA) is a non-adhesive but cohesive liquid embolic agent that can be used to occlude vascular lesions. On label indications are for...

Endovascular Balloon-Assisted Embolization of Intracranial and Cervical Arteriovenous Malformations Using Dual-Lumen Coaxial Balloon Microcatheters and Onyx

Abstract BACKGROUND: Ethylene vinyl alcohol copolymer (Onyx) is widely used for the embolization of arteriovenous malformations (AVMs) of the brain, head, and neck. Balloon-assisted Onyx embolization may provide additional unique advantages in the treatment of AVMs in comparison with traditional catheter-based techniques. OBJECTIVE: To report our initial experience in performing balloon-assisted AVM embolization for brain and neck AVMs with the use of the new Scepter-C and Scepter-XC coaxial dual-lumen balloon microcatheters. METHODS: Balloon-assisted transarterial embolization was performed in a series of 7 patients with AVMs (4 with brain AVMs, 1 with a dural arteriovenous fistula, and 2 with neck AVMs) by using Onyx delivered through the lumen of Scepter-C or Scepter XC coaxial balloon microcatheters. Following the initial balloon-catheter navigation into a feeding artery and the subsequent inflation of the balloon, the embolization was performed by using Onyx 18, Onyx 34, or both. RESULTS: A total of 12 embolization sessions were performed via 17 arterial feeders in these 7 patients. In 1 patient, there was an arterial perforation from the inflation of the balloon; in all others, the embolization goals were successfully achieved with no adverse events. CONCLUSION: The balloon microcatheters showed excellent navigability, and there were no problems with retrieval or with the repeated inflation and deflation of the balloons. A proximal Onyx plug, which is crucial in many AVM embolizations, was not necessary with this technique. Additionally, fluoroscopy and procedural times seemed lower with this technique compared with conventional embolization methods.

Endovascular Balloon-Assisted Embolization of Intracranial and Cervical Arteriovenous Malformations Using Dual Lumen Co-axial Balloon Microcatheters and Onyx

Endovascular Balloon-Assisted Embolization of Intracranial and Cervical Arteriovenous Malformations Using Dual Lumen Co-axial Balloon Microcatheters and Onyx

Abstract TMP120: Endovascular Balloon-Assisted Embolization of Intracranial Arteriovenous Malformations Using Dual Lumen Co-Axial Balloon Microcatheters and Onyx: Initial Experience.

Background: Ethylene Vinyl alcohol co-polymer (Onyx) is widely used for embolization of intracranial arteriovenous malformations. Traditional catheter based techniques for Onyx infiltration may be associated with reflux of Onyx resulting in cathteter retention, vessel rupture or reflux into en-passage arteries. Balloon assisted Onyx embolization may eliminate some of these problems encountered with traditional catheter based techniques. Herein, we report our initial experience in performing balloon assisted AVM embolization for brain AVMs and dural AVFs using the new Scepter-C and Scepter-XC co- axial dual lumen balloon microcatheters. Methods: Balloon-assisted trans-arterial embolization was carried out in a series of six patients (5 with brain AVMs, one with a dural AVF ) using Onyx delivered through the lumen of Scepter-C or Scepter XC co-axial balloon microcatheters. Following initial balloon-catheter navigation into a feeding artery as close to the nidus of the malformation as possible, and subsequent balloon inflation, embolization was performed using Onyx 18 or Onyx 34 or both. The balloon was delated and removed once adequate embolization had been achieved. Results: A total of ten embolization sessions were performed via fifteen arterial feeders in these five patients. In one out of fifteen vessels (7%), there was a quickly controlled arterial perforation from balloon inflation, in all others embolization goals for each session were successfully achieved with no adverse events. Conclusion: We found that the balloon microcatheters showed excellent navigability and there were no problems with retrieval or repeated inflation and deflation of the balloons. Using this technique, we were able to avoid the need for formation of a proximal Onyx plug and its associated risks. Additionally, fluoroscopy and procedural times seemed lower with this technique compared to conventional embolization methods.

Mechanical revascularization of acute iatrogenic anterior cerebral artery occlusions: use of a new coaxial dual-lumen balloon catheter results in rapid access and flow restoration

Acute iatrogenic occlusion of cerebral vessels is a risk during the performance of neuroendovascular procedures. Most commonly this is a result of thrombus formation within the vessel, thromboembolism or an...

Combined balloon stent technique with the Scepter C balloon and low-profile visualized intraluminal stent for the treatment of intracranial aneurysms

BackgroundThe ‘balloon-then-stent’ method involves stent placement after completion of a balloon-assisted embolization. The drawback to this technique is that the coil mass achieved during balloon remodeling must be crossed prior...

P-009 Endovascular balloon-augmented embolization of intracranial and cervical arteriovenous malformations using a dual lumen coaxial balloon microcatheter: initial experience

BackgroundTransarterial embolization with ethylene vinyl alcohol copolymer (EVOH) Onyx (ev3, Neurovascular, Irvine, CA) is a popular method for endovascular management of arteriovenous malformations (AVMs) and fistulas. Successful embolization depends on...

P-015 Initial experience with a coaxial dual-lumen balloon catheter for wide-neck aneurysm coil embolization

IntroductionTechniques for coil-embolization of wide-neck cerebral aneurysms include the use of stents and temporary occlusion with compliant non-detachable balloons to achieve safe and densely packed coil positioning. We describe the...

Initial Experience with the Coaxial Dual-Lumen Ascent Balloon Catheter for Wide-Neck Aneurysm Coil Embolization

Introduction: Techniques for coil embolization of wide-neck cerebral aneurysms include the use of stents and temporary occlusion with compliant non-detachable balloons to safely allow dense packing of the aneurysm lumen with detachable coils. We describe the use of a new balloon device for assisting in wide-neck aneurysm coil treatment. Methods: A single institution neuroendovascular database was accessed to identify cases in which the Ascent balloon (Codman Neurovascular, Raynham, MA, USA) was used for aneurysm coil embolization. Clinical, demographic, and angiographic data were obtained through chart review. Results: Eleven cerebral aneurysm cases were treated using the Ascent balloon during the first 12-month period that the new device was available at our institution. Three of the patients presented with ruptured aneurysms. All aneurysms were large (maximum diameter 6 mm or greater), with an average maximum diameter of 9.4 mm, and an average neck diameter of 5.5 mm. Complete occlusion with coil embolization (Raymond class I) was achieved in all cases. The Ascent balloon was successfully positioned across the neck of the aneurysm in nine patients. Conclusion: This initial experience demonstrates the feasibility and immediate outcomes of the coaxial dual-lumen design Ascent balloon catheter used as an assistive device in coil embolization of wide-neck cerebral aneurysms. This device contributes to the growing number of assistive devices for the treatment of complex cerebral aneurysms.

Minimally invasive treatment of urethral strictures in men

Minimally invasive treatments of urethral strictures in men intend to durably restore normal anatomy and function with relief of urinary symptoms and avoidance of morbidity. Minimally invasive treatments for bulbar urethral strictures include bougienage and coaxial balloon dilation, endoscopic urethrotomy with a cold-knife or laser, and urethral wall stents. Adjunctive techniques including brachytherapy and the injection of steroids, mitomycin C, or captopril, have been employed to reduce the high restricture rates with minimally invasive treatments for bulbar urethral strictures. This review discusses recently published data concerning indications for these commonly performed minimally invasive procedures, along with their efficacy, durability, and potential for adverse events. Although many currently available studies report on small numbers of patients, some conclusions can be made. Ultimately, long-term, randomized, controlled prospective studies of larger numbers of men with bulbar urethral strictures are needed.

Development of a New Coaxial Balloon Catheter System for Balloon-Occluded Retrograde Transvenous Obliteration (B-RTO)

To develop a new coaxial balloon catheter system and evaluate its clinical feasibility for balloon-occluded retrograde transvenous obliteration (B-RTO). A coaxial balloon catheter system was constructed with 9 Fr guiding balloon catheter and 5 Fr balloon catheter. A 5 Fr catheter has a high flexibility and can be coaxially inserted into the guiding catheter in advance. The catheter balloons are made of natural rubber and can be inflated to 2 cm (guiding) and 1 cm (5 Fr) maximum diameter. Between July 2003 and April 2005, 8 consecutive patients (6 men, 2 women; age range 33-72 years, mean age 55.5 years) underwent B-RTO using the balloon catheter system. Five percent ethanolamine oleate iopamidol (EOI) was used as sclerosing agent. The procedures, including maneuverability of the catheter, amount of injected sclerosing agent, necessity for coil embolization of collateral draining veins, and initial clinical results, were evaluated retrospectively. The occlusion rate was assessed by postcontrast CT within 2 weeks after B-RTO. The balloon catheter could be advanced into the proximal potion of the gastrorenal shunt beyond the collateral draining vein in all cases. The amount of injected EOI ranged from 3 to 34 ml. Coil embolization of the collateral draining vein was required in 2 cases. Complete obliteration of gastric varices on initial follow-up CT was obtained in 7 cases. The remaining case required re-treatment that resulted in complete obstruction of the varices after the second B-RTO. No procedure-related complications were observed. B-RTO using the new coaxial balloon catheter is feasible. Gastric varices can be treated more simply by using this catheter system.

Development of an inflatable and drug-releasing coaxial double balloon catheter

Development of an inflatable and drug-releasing coaxial double balloon catheter