Fr Microcatheter Research Articles

A novel cerebral ischemia-reperfusion model using intraluminal filament in rabbit

Abstract Introduction Stroke models are based on permanent or transient occlusion of cerebral arteries. Despite transient occlusion model tends to produce more variable results, it can investigate reperfusion. Although ischemia-reperfusion model is well established in rat using a silicone-filament by exposition of carotid artery, the endovascular approach in large animal is still a challenge. The purpose was to develop a novel cerebral ischemia-reperfusion model in rabbit using an intraluminal wire by means of an endovascular approach and subsequent assessed by MRI. Methods Four New Zealand rabbits (4-5 kg) underwent cerebral ischaemia-reperfusion. A 4Fr introducer sheath was inserted into the femoral artery. Under fluoroscopy, a 4Fr Cobra catheter was placed into the common carotid artery. A 1.9Fr microcatheter was inserted coaxially into the internal carotid artery, and a 0.014” microwire was advanced into the middle cerebral artery (MCA). Alternatively, the posterior cerebral artery (PCA) was occluded through the vertebral artery when the above approach failed. After 1 hour, reperfusion was performed by withdrawing the microwire. MRI examinations were conducted from 1 to 3 hours later. Results Technical success was achieved in three out of four animals, with the MCA reached in two rabbits and the PCA in one. In the rabbit with technical failure, it was impossible to advance the microwire into either the MCA or PCA due to the tortuosity of the vessels and vasospasm. Conclusion Ischemia-reperfusion model in rabbit though an intraluminal wire may provide a new model using an endovascular approach for the earlier research of transient stroke.

Effective Management of Ileocecal Hemorrhage with Super-Selective Arterial Embolization: A Case Study

Background: Acute colonic bleeding, including rectal bleeding and melena, affects approximately 36 per 100,000 people annually, with a higher incidence in the elderly. Effective management requires prompt diagnosis and intervention, especially for severe cases characterized by persistent bleeding and significant decreases in hemoglobin levels. Traditional therapeutic options include pharmacologic therapy, endoscopic coagulation, transcatheter therapy, and surgery. While percutaneous embolization is established for upper GI bleeding, its effectiveness for lower GI bleeding remains debated due to concerns over potential intestinal infarction. Methods: We present a case of a 31-year-old female with a history of severe mitral regurgitation and chronic atrial fibrillation who underwent mitral valve replacement. Post-operatively, she developed black tarry stools indicative of lower GI bleeding. Initial treatments, including proton pump inhibitors, tranexamic acid, and vitamin K, were ineffective. Gastroscopy and colonoscopy showed no active bleeding, but abdominal CT revealed contrast extravasation at the ileocecal junction, likely from the ileocolic artery. Super-selective arterial embolization was performed using a 6 Fr femoral sheath and microcatheter (2.7 Fr) with non-spherical polyvinyl alcohol (nsPVA) particles (355-500 μm) to target the bleeding source. Results: The embolization successfully halted hematochezia with no signs of peritonitis or mesenteric infarction. Post-procedure, the patient was discharged after 4 days with no abdominal pain or readmission for complications. Conclusion: Super-selective arterial embolization is a safe and effective method for managing lower GI bleeding, with no observed intestinal infarction in this case. This approach demonstrates the feasibility of embolization in controlling severe colonic hemorrhage, potentially offering a viable alternative to more invasive procedures while minimizing the risk of bowel ischemia.

ANGIOEMBOLISATION OF CREMASTERIC ARTERY FOR SCROTAL HAEMATOMA FOLLOWING HERNIAL REPAIR

Cremasteric artery is a branch of inferior epigastric artery supplying the cremaster muscle and coverings of the cord. The possible consequence of injury to this artery is scrotal haematoma. We present a case of haemorrhage from unexpected cresmastric artery injury post-hernioplasty treated with angioembolisation. To the best of our knowledge, this has not been reported in literature.
 A 66-year-old gentleman with left indirect inguinal hernia underwent a left inguinal hernioplasty in our institution with no immediate complications. However he presented to the emergency department the day after the procedure with complaints of rapidly worsening painful left scrotal swelling accompanied with symptoms of intestinal obstruction. Emergency laparotomy and re-do left hernioplasty was performed, revealing a strangulated inguinoscrotal hernia. Post-operatively, there was non-resolving scrotal swelling with a drop in the haemoglobin level; from 11.9g/dl to 8.5g/dl requiring packed cell transfusion. CT angiogram revealed active contrast extravasation from the left cremasteric artery. Angiographic run confirmed the finding and the left cresmatric artery was superselectively cannulated with a 1.9Fr microcatheter and embolization done with 0.5mm microcoil. Ultrasound scan 24-hour post-procedure showed patent proximal vessel. Clinically there was a reduction of the left scrotal swelling and the haemoglobin remained stable. 
 Cremasteric artery courses laterally deep into the fascia transversalis entering the cord deep to the internal spermatic fascia to supply the cremaster muscle and coverings of the cord. This course renders the artery to be prone for injury during procedure such as hernioplasty; one of the possible consequences is scrotal haematoma. This artery is usually small in caliber and its identification is important for efficient and effective treatment.
 Angioembolisation is able to treat this injury with superior precision owing to its ability for localization and selective cannulation of the offending vessel.

Potential feasibility of a novel over-the-wire microelectrode catheter for recording coronary sinus electrograms in patients with cardiac resynchronization therapy devices.

The placement of an electrode catheter into the coronary sinus (CS) is important for differentiating multiple atrial tachycardias (ATs). Based on its high selective performance in placement into small veins, inserting a novel over-the-wire 2.7Fr microcatheter (EPstar Fix AIV; Japan Lifeline) into the CS may be feasible even in patients implanted with a cardiac resynchronization therapy device.

P07 Single centre experience of the balloon occlusion microcatheter for prostate artery embolisation (PAE)

Abstract Introduction Prostate artery embolization (PAE) is an effective in patients with benign prostatic hyperplasia (BPH) particularly. Balloon occlusion PAE (bPAE) is novel procedural adaption to the standard technique using a 2.2fr microcatheter with a compliant silicone balloon. Methods Retrospective single centre study of the first experience of balloon occlusion microcatheter for PAE in the UK. All patients undergoing PAE in the last 18 months were identified and those who had bPAE were included. Results 22 patients were included in the study mean age 72 (11 IQR, 67.25-78.2). Median prostate volume was 121g (86.75 IQR, 57.5- 144.25). Median IPSS, Qmax and PVR at base line were 19 (5.25 IQR, 16-21.25), 7.4 ml/s (4.27 IQR, 5-9.35), 188 mls (255 IQR, 42.5 - 298) respectively. Four patients had long term catheters pre-procedure. Patients were embolised with 45-150 µm Contour PVA particles (n=8) or 250 µm Embozene microspheres (n = 14) (Boston Scientific, MA, USA). At 3 months post bPAE, MRI demonstrated prostate volume reduction of 31% (37.5± IQR, 11-48.5) with a further infarct of a median of 5ml (9.6 IQR, 0.95-10.6). IPSS reduction of 11 points (8.5 IQR, 7-15.5), Qmax of 11.6 ml/s (13.4 IQR, 4.8-18.2) and PVR of 98 mls (161 IQR, 19-180). Conclusion Balloon occlusion PAE is effective in reducing lower urinary tract symptoms. It effectively reversed the penile and rectal shunts in 8/22 cases with no cases of non-target embolization.

PILOT STUDY FOR THE CREATION OF A STROKE MODEL IN RABBITS USING ENDOVASCULAR TECHNIQUES

Abstract Introduction Due to the clinical implications of stroke in patients, the “2IQBIONEURO” project promoted by the Interreg VA Spain-Portugal programme (POCTEP) aims to study the treatment of neurological diseases associated with ageing. The aim was to evaluate the feasibility of the technique of selective cerebral artery (CA) embolisation for the creation of a stroke model in rabbits. Methods In 3 rabbits, through a 4Fr introducer in the femoral artery, a 4Fr Cobra catheter and 0.035″ guide was placed in the aortic arch to perform angiography of the brachiocephalic trunk. Under road-mapping, the right common carotid artery was catheterised, and its bifurcation into its external and internal branches was visualised with angiography in an oblique position (90°). With a 1.5Fr microcatheter and 0.008″ microguidewire inserted coaxially, the internal carotid artery was catheterised to perform superselective angiography of the cerebral vasculature. The microcatheter was positioned in the CA for embolisation by injection of PVA (100–200 µm) until stasis was reached as an end point or when reflux occurred. MRI monitoring was performed before and after embolisation (2, 5 and 24 hours). After 24 hours, neurological evaluation and macroscopic postmortem study with tetrazolium were performed. Results Successful occlusion of the CA was achieved in all animals whose lesion was observed on MRI. Conclusions The development of a stroke model in rabbits by selective embolisation of the CA is feasible, and can be used for the preclinical study of stroke.

Novel dry pericardiocentesis: Transvenous puncture of the right ventricle with the back end of a 0.014-inch PTCA guidewire and a 1.8 Fr microcatheter.

BackgroundDry transthoracic pericardiocentesis is challenging and carries the risk of right ventricle (RV) or coronary artery injury. The RV can usually control bleeding automatically. For example, most perforations of the RV caused by pacemaker leads are treated without open surgery. Thus, we performed a transvenous puncture of the RV for dry pericardiocentesis with the back end of a 0.014-inch percutaneous transluminal coronary angioplasty (PTCA) guidewire and a 1.8 Fr microcatheter.MethodsThe back end of a 0.014-inch PTCA guidewire within a 1.8 Fr microcatheter was used to transvenously punctured through the middle of the acute margin of the RV into the pericardial space in 12 Yorkshire swine and 5 beagles. PTCA balloons of different diameters were used to dilate the puncture holes for 15 min under anticoagulation in all the animals to assess the ability of the RV to control the bleeding. Then, for 3 days, the puncture hole was dilated by a 6 Fr catheter in 9 swine and 5 dogs.ResultsThe puncture was successful in all the animals. After withdrawal of the 2.5-mm balloon or the 6 Fr catheter, none of the animals exhibited pericardial effusion, as observed by echocardiography. There was no sustained ventricular arrhythmia or other complications. All the animals survived.ConclusionTransvenous puncture of the right ventricle with the back end of a 0.014-inch PTCA guidewire and 1.8 Fr microcatheter may be feasible and have a good safety margin.

The first experience of partial spleen embolization for the correction of thrombocytopenia in patients with liver cirrhosis

Aim. To assess the efficacy and safety of interventional endovascular partial spleen embolization for the correction of thrombocytopenia in patients with liver cirrhosis.Material and methods. From September 2019 to March 2020, 5 partial spleen embolizations were performed at the surgical clinic of the Botkin Hospital. The indication was the impossibility of conducting courses of regional chemotherapy for primary liver cancer in 2 patients with cirrhosis, portal hypertension, hypersplenism, thrombocytopenia, in 3 patients – the impossibility of conducting adequate antiviral therapy with cirrhosis as a result of chronic viral hepatitis C. The platelet count was < 25 thousand/μl (19.34 ± 1.34 thousand/μl) in all patients at the time of the procedure. The median spleen volume was 1967.54 ± 476.13 (1324.34–2163.54) cm3 . We used Progreat® Terumo 2.8 Fr microcatheter 130 cm for catheterization branches of the splenic artery. Endovascular embolization was performed with microspheres 600 ± 75 nm – 2 ml before occlusion. Computed tomography scan of abdominal cavity with intravenous contrast enhancement and laboratory test of platelet levels were performed. Follow up of patients was carried out at 1, 3 and 6 months after this intervention.Results. The postoperative period in all patients was uncomplicated. Postembolization syndrome (pain, hyperthermia) developed in the early postoperative period in all patients on the next day after the procedure. Computed tomography scan of the abdominal cavity revealed areas of an irregular shape of low density that did not accumulate a contrast agent. The duration of hospitalization was 7.63 ± 3.32 (5–11) days. There were not in-hospital and 30-day mortality in our study.Conclusion. The first experience of endovascular partial spleen embolization showed its safety and efficacy in the correction of thrombocytopenia in patients with liver cirrhosis.

Traumatic prolonged hematuria and pseudoaneurysm of the renal segmental arterial branch in a 16-year-old boy treated by endovascular embolisation

Most renal injuries in pediatric patients are treated conservatively, but prolonged hematuria and major blood vessel injuries often require active bleeding control. Traumatic pseudoaneurysms of segmental branches of the renal artery occur in 2.5% of renal injuries. They usually manifest as prolonged or intermittent secondary hematuria, but may be asymptomatic as well. Watchful waiting is the initial treatment, and around one third of patients eventually require active surgical or endovascular treatment. The two main endovascular coil embolisation methods are the “sandwich” and the “coil packing” technique, but occlusion using a stent is also possible. Traumatic prolonged hematuria caused by pseudoaneurysm of the renal segmental arterial branch, and the methods of treatment are rarely reported, especially in children. This report presents a boy in whom a blunt kidney injury lead to the formation of a pseudoaneurysm of the renal segmental arterial branch, causing prolonged hematuria. The patient was treated by endovascular embolisation through the right femoral artery, in local anesthesia and conscious sedation. A 2.7 Fr microcatheter was used to selectively enter the dominant cranial renal artery and show the pseudoaneurysm of a segmental interlobar arterial branch. A 2×4 mm coil was used to occlude the segmental interlobar arterial branch and pseudoaneurysm, with no post-procedural bleeding or significant renal segmental ischemia. Endovascular treatment offers advantages over open surgery, but has certain drawbacks as well, such as high radiation and contrast exposure. In the last few years, a minimally invasive robotic surgical procedure has been described for the treatment of intra-renal pseudoanurysm. The current worldwide trend in pediatric renal injuries treatment is the reduction in the number of nephrectomies, and a shift to non-operative and minimally invasive treatment, including endovascular procedures. University Hospital Centre Zagreb has all the specialities and capacities required for surgical and endovascular procedures in children, making it the national referral centre for pediatric renal injuries treatment.

Abstract No. 171 Validating an ex-vivo bovine kidney pulsatile perfusion model with micro-CT evaluation of distal angioembolization

Development of a reliable and affordable ex-vivo bovine kidney perfusion model has great potential for further advancing the field of interventional radiology (IR) and minimizing in-vivo animal research. We aim to validate our model for ex-vivo bovine kidney pulsatile perfusion by utilizing microscopic computed tomography (mCT) evaluation of distal angioembolization. Bovine kidneys were obtained directly from a local slaughterhouse. Immediately, the renal artery was flushed with heparinized saline. Organs were then transported on ice to the perfusion lab. Renal artery was cannulated to 3/8” tubing, and renal vein was cannulated with an inflated 16-Fr Foley catheter for collection of venous output. A roller pump was used for pulsatile arterial perfusion. Arterial tubing was set up with an in-line blood pressure (BP) monitor and a one-way valve for intraprocedural BP control. A 5 Fr sheath was placed in the arterial tubing to serve as vascular access. The kidney was mounted over a reservoir of heparinized saline perfusate. The pump would receive perfusate from this reservoir. Kidneys were perfused for 10 minutes prior to beginning the experiment. Two integrated-IR residents were primary operators with attending intraprocedural supervision in a DSA lab. A series of 4 ex-vivo bovine kidney perfusion protocols were successfully performed. Segmental embolization was performed using a 2.8 Fr microcatheter supported by a 5 Fr guiding catheter. Embolization was to contrast stasis. The following variables were collected: kidney pre- and post-perfusion weight, intraprocedural BP, embolic material volume delivered, DSA images, and distal embolization assessed by mCT vascular distribution. Average pre- and post-perfusion weights were found to have a statistically significant increase (P< .05). Intraprocedural BP averaged 140+25mmHg systolic and 61+14mmHg diastolic. 57 minutes were spent perfusing the organ. All post embolic DSAs revealed successful embolization. In a pulsatile perfused ex vivo bovine kidney, microbeads demonstrated stability, fair homogeneity, and microembolization below 40 um vessels without significant venous distribution. Our ex-vivo kidney pulsatile perfusion model is reliable, replicable, and provides a platform where microembolization experiments can be performed. This perfusion model has applications in translational and educational research.

Retrograde embolization technique of the right gastric artery during the implantation of port-catheter system for hepatic arterial infusion chemotherapy

ObjectiveThis study aimed to introduce and evaluate a new embolization technique for the right gastric artery (RGA) during percutaneous implantation of a port-catheter system for hepatic arterial infusion chemotherapy (HAIC). MethodsFrom January 2013 to January 2017, 159 patients with unresectable advanced liver cancer underwent percutaneous implantation of a port-catheter system. In 86 of these patients (56 men; aged 28–88 years; mean: 60.6 ​± ​12.0 years), in whom the RGA was obvious on arteriography, embolization of RGA was attempted using microcoils to protect the gastric mucosa during HAIC. In the first phase (first three years), antegrade embolization of the RGA using a 2.7 Fr microcatheter was performed in 55 patients. In the second phase (next two years), embolization of the RGA was attempted by combining antegrade embolization and retrograde embolization through the left gastric artery (LGA) in 31 patients. The success rates and the incidence of acute gastroduodenal mucosal toxicity (AGMT) in these two groups were compared. ResultsThe total success rate of the RGA embolization was 70.9%. The success rate was 83.9% in 31 patients who underwent combined antegrade and retrograde embolization, which was significantly higher than that of antegrade embolization alone (63.6%) performed in 55 patients (p ​= ​0.047). No complications related to embolization of RGA were documented. The incidence of AGMT was 29.1% (16/55) in patients in the first phase, which was significantly higher than that in the patients in the second phase (9.7%, 3/31) (p ​= ​0.037). ConclusionA combination of retrograde embolization via LGA could increase the success rates of RGA embolization and reduce the incidence of AGMT after HAIC.

Synthesis of Injectable Shear-Thinning Biomaterials of Various Compositions of Gelatin and Synthetic Silicate Nanoplatelet.

Injectable shear-thinning biomaterials (iSTBs) have great potential for in situ tissue regeneration through minimally invasive therapeutics. Previously, an iSTBwas developed by combining gelatin with synthetic silicate nanoplatelets (SNPs) for potential application to hemostasis and endovascular embolization. Hence, iSTBs are synthesized by varying compositions of gelatin and SNPs to navigate their material, mechanical, rheological, and bioactive properties. All compositions (each component percentage; 1.5-4.5%/total solid ranges; 3-9%) tested are injectable through both 5 Fr general catheter and 2.4 Fr microcatheter by manual pressure. In the results, an increase in gelatin contents causes decrease in swellability, increase in freeze-dried hydrogel scaffold porosity, increase in degradability and injection force during iSTB fabrication. Meanwhile, the amount of SNPs in composite hydrogels is mainly required to decrease degradability and increase shear thinning properties of iSTB. Finally, in vitro and in vivo biocompatibility tests show that the 1.5-4.5% range gelatin-SNP iSTBs are not toxic to the cells and animals. All results demonstrate that the iSTB can be modulated with specific properties for unmet clinical needs. Understanding of mechanical and biological consequences of the changing gelatin-SNP ratios through this study will shed light on the biomedical applications of iSTB on specific diseases.

Abstract No. 438 Tail artery access for transarterial experiments in rats: feasibility study in a survival model

The rat is an increasingly valuable model to study interventional therapeutic procedures. Suitable arterial access is essential for vascular intervention. In rats, transtail artery access has been recently reported as a feasible technique compared to conventional carotid or femoral access. The aim of this study was to evaluate repeat accessibility and complications of transtail angiography in a survival model. Seventeen male Sprague-Dawley rats were used (460.2 ± 45.0g), one rat died before the procedure, hence 16 rats were included in this study. 1-cm longitudinal ventral incisions were created 5 cm distal to the base of the tail to dissect the tail artery (ventral caudal artery). A 1.5–1.7 Fr microcatheter was advanced over a 0.010–0.014 inch microguidewire through a partial arteriotomy. Selective renal angiography was then performed. Intraarterial antibiotics injection was performed in 11 of 16 rats. The accessed segment of the tail artery was ligated and the incision closed with sutures. Repeat renal angiography via the tail artery was performed 48 hours after the initial procedure using a separate tail incision 1 cm proximal to the initial incision. Procedure time from skin incision to catheterization was recorded. Complications including tail ischemia, infection and bleeding were evaluated during the 2-day follow-up period. All initial and repeat procedures were successfully performed. The average time for the 32 tail artery cannulations was 11.0 ± 4.5 min. Transient focal skin color change in the tail was observed in one rat immediately after the initial procedure, which resolved within 90 mins. No tail necrosis, major bleeding or signs of infection were observed. Dehiscence of the incision was observed in 3 of 16 rats from self-grooming, with no bleeding or infection. Repeat tail artery access for angiography in rats was successful without major complications in a survival model. This reproducible technique can provide a new experimental platform to test transarterial procedures.

A dual-functional Embolization-Visualization System for Fluorescence image-guided Tumor Resection.

Rationale: Intraoperative bleeding impairs physicians' ability to visualize the surgical field, leading to increased risk of surgical complications and reduced outcomes. Bleeding is particularly challenging during endoscopic-assisted surgical resection of hypervascular tumors in the head and neck. A tool that controls bleeding while marking tumor margins has the potential to improve gross tumor resection, reduce surgical morbidity, decrease blood loss, shorten procedure time, prevent damage to surrounding tissues, and limit postoperative pain. Herein, we develop and characterize a new system that combines pre-surgical embolization with improved visualization for endoscopic fluorescence image-guided tumor resection.Methods: Silk-elastinlike protein (SELP) polymers were employed as liquid embolic vehicles for delivery of a clinically used near-infrared dye, indocyanine green (ICG). The biophysical properties of SELP, including gelation kinetics, modulus of elasticity, and viscosity, in response to ICG incorporation using rheology, were characterized. ICG release from embolic SELP was modeled in tissue phantoms and via fluorescence imaging. The embolic capability of the SELP-ICG system was then tested in a microfluidic model of tumor vasculature. Lastly, the cytotoxicity of the SELP-ICG system in L-929 fibroblasts and human umbilical vein endothelial cells (HUVEC) was assessed.Results: ICG incorporation into SELP accelerated gelation and increased its modulus of elasticity. The SELP embolic system released 83 ± 8% of the total ICG within 24 hours, matching clinical practice for pre-surgical embolization procedures. Adding ICG to SELP did not reduce injectability, but did improve the gelation kinetics. After simulated embolization, ICG released from SELP in tissue phantoms diffused a sufficient distance to deliver dye throughout a tumor. ICG-loaded SELP was injectable through a clinical 2.3 Fr microcatheter and demonstrated deep penetration into 50-µm microfluidic-simulated blood vessels with durable occlusion. Incorporation of ICG into SELP improved biocompatibility with HUVECs, but had no effect on L-929 cell viability.Principle Conclusions: We report the development and characterization of a new, dual-functional embolization-visualization system for improving fluorescence-imaged endoscopic surgical resection of hypervascular tumors.

Technical and anatomical factors affecting intra-arterial chemotherapy fluoroscopy time and radiation dose for intraocular retinoblastoma

BackgroundIntra-arterial chemotherapy has an increasingly prominent role in the management of retinoblastoma. One concern regarding this technique is procedural radiation exposure.ObjectivesTo examine the effects of our institution’s procedural technique on...

310 Differences in Stump Pressures Between Ruptured and Un-Ruptured Intracranial Aneurysms

Abstract INTRODUCTION We present the largest prospective cohort of intra-saccular pressure recordings of ruptured and non-ruptured intracranial aneurysms. METHODS Aneurysmal dome pressure was collected using a standard 1.8 Fr micro-catheter which was navigated into the dome of the aneurysm under continuous roadmap and fluoroscopic guidance taking care to avoid placement against the wall and past the neck. Once in place, a transducer was attached to the proximal end of the micro-catheter to measure stump pressures for an estimated 60 seconds and only considered valid when clear systole and diastole profiles were observed. Transducer re-zeroing and line re-prepping was performed in the absence of systole and diastole profiles to confirm invalid data prior to data exclusion. RESULTS &gt;A prospective cohort of 38 patients were included in the study. 8 patients' data were discarded due to poor waveform during measurement. Of the remaining 30 patients, 14 presented with ruptured aneurysms while 16 were elective non-ruptured cases. The mean pulse pressure in non-ruptured cases was 21.7 with standard deviation of 17.0 compared to mean of 5.8 and standard deviation of 5.0 in ruptured cases. In addition the average systolic aneurysm pressure was 91% of the systolic blood pressure in non-ruptured cases compared to 78% in ruptured cases. CONCLUSION There is a significant difference noted in systolic and overall pulse pressures between ruptured and non-ruptured aneurysm groups with P = 0.05 and 0.005 respectively. This finding could be due to rupture effect phenomenon in which case this technique could aid in differentiating between ruptured and non-ruptured aneurysms. We hypothesize that lower aneurysm systolic and pulse pressures could be suggestive of low wall shear stress at the aneurysm dome which has been implicated in secondary inflammation of the aneurysm wall leading to aneurysmal rupture. This information could be important for risk stratification of non-ruptured intracranial aneurysms.

Pulmonary Arteriovenous Malformations Embolized Using a Micro Vascular Plug System: Technical Note on a Preliminary Experience.

To report our preliminary experience using a Micro Vascular Plug (MVP) deployed through a 2.8Fr micro-catheter for the treatment of pulmonary arteriovenous malformations (PAVMs) in a cohort of patients affected by Hereditary Haemorrhagic Telangiectasia (HHT). Four consecutive female patients (mean age 38.0years; range 25-55years) with PAVMs diagnosed on echocardiogram/bubble test and contrast-enhanced CT (CECT) underwent MVP embolization. One patient was symptomatic with recent transient ischaemic attack. Follow-up was undertaken at 1-month post-procedure with CECT to assess PAVMs permeability and MVP positioning and at 1-, 6-, and 12-month post-procedure, with echocardiography/bubble test and standard neurological history, to confirm absence of right-to-left shunts and recurrent symptoms. Eight PAVMs were treated in 4 patients over 5 interventional sessions (mean 1.6 PAVMs per session). All PAVMs were simple, with mean feeding artery diameter of 4.25mm. Eight 6.5mm MVPs were deployed in total (one per lesion). Technical success was 100%. Mean procedural time and patient dose per session were 70min (range 40-70min) and 53418mGy.cm2 (range 6113-101628mGy.cm2), respectively. No signs of reperfusion neither of MPV migration were noted at 1-month CECT follow-up. At early follow-up (mean 3.75months; range 1-12months), clinical success was 100% with no evidence of recurrent right-to-left shunt, and no neurological symptoms. No immediate or late complications were observed. MVP embolization of PAVMs appears technically feasible, safe, and effective at early follow-up. Further prospective studies are required to confirm long-term safety and efficacy of this promising technique.

Iatrogenic Pseudoaneurysm of the Meningohypophyseal Trunk; A Rare Complication of Trans-sphenoidal Surgery

This 33-year-old man was diagnosed with pituitary macroadenoma and underwent microscopic trans-sphenoidal resection in the department of neurosurgery. His laboratory finding showed an increased level of prolactin and he had no neurologic deficit. Magnetic resonance imaging (MRI) showed a pituitary macroadenoma with invasion of the right cavernous sinus. Previously, he was not administered with bromocriptine. During exposure of the sella via a trans-sphenoidal access, it was found that the residual tumor was attached to the right cavernous sinus. In an attempt of tumor resection, it was complicated due to unexpected intraoperative arterial bleeding, which was temporarily arrested by nasal packing using gelfoam and hemostatic matrix (FloSeal; Baxter Inc., Deerfield, IL). The patient remained intact without neurologic deficit. Immediately after operation, brain MRI showed formation of a pseudoaneurysm near the resection margin, and cerebral angiography revealed a 2.5 mm-sized pseudoaneurysm from the right MHT (Fig. 1a and b). EVT was decided due to the patient’s condition and surgical risk, and an informed consent was obtained. Via the right femoral artery access, a 6 Fr guiding catheter (Envoy, Codman Neurovascular, Raynham, MA) was introduced into the right ICA. A 2.0 Fr microcatheter (preshaped J Excelsior, Stryker, Fremont, CA) was navigated into the proximal MHT under guidance of a 0.014-inch microwire (Synchro-2, Stryker) and advanced into the saccular lumen Introduction

E-015 Novel Endovascular Device for Immediate, Complete, and Sustained Occlusion of Saccular Cerebral Aneurysms

IntroductionUsing a canine model of a large, terminal, carotid artery, venous pouch aneurysm, a comparison was made between treatment with standard coils and treatment with the Ballstent MicrocatheterTM.MethodsFor the pilot...

Abstract No. 401 - Ballstent deployment results in immediate cerebral aneurysm occlusion

Purpose To design a new medical device for occlusion of cerebral aneurysms, build a prototype, and complete an initial pilot nonclinical study. Materials and Methods A prototype of the Ballstent Microcatheter was designed and manufactured. An 8 mm round balloon made of gold with a 10 micron thick wall was manufactured using electroforming. The Ballstent was mounted on a 3.5 Fr microcatheter using an elastic sleeve to firmly hold the neck of the Ballstent onto the distal end of the microcatheter. The Ballstent was folded, wrapped and compressed onto the distal end of the microcatheter. A 0.018” nitinol wire was used as an obturator. An 8 mm experimental aneurysm was made in a 25 kg dog using a segment of external jugular vein sewn into a bifurcation created between the left and right carotid arteries. A 6 Fr guide sheath was advanced near the opening of the newly created aneurysm and the compressed Ballstent was advanced into the aneurysm sac, expanded, and detached from the delivery microcatheter by advancing the tip of the sheath and pulling back on the delivery microcatheter. Results The treatment phase of the study was completed in less than five minutes. The prototype demonstrated excellent fluoroscopic visibility, trackability and deliverability. The Ballstent expanded in a controlled manner within the aneurysm sac at a pressure of less than 1 atmosphere, resulting in immediate occlusion of the aneurysm. Conclusion The Ballstent microcatheter is a promising new device for the treatment of saccular cerebral aneurysms and offers the potential for short and simple treatments and near complete filling and sealing of aneurysms using a single device. A chronic nonclinical study is planned for Q4 2012.