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scepter (n.)

Because stents require dual antiplatelet medication, balloons appear to be favorable for the treatment of ruptured aneurysms. Additionally, a balloon catheter is often useful when saving a branch incorporated into the aneurysm sac during coiling 1. This balloon catheter requires a balloon-specifically 0. The Scepter balloon is a newer double lumen balloon for the remodeling technique in aneurysm coil embolization. The purpose of this study is to evaluate the initial results of this device for the treatment of wide-necked cerebral aneurysms. All patients were registered in the recorded neuro-interventional database prospectively.

Patients included 11 women and 6 men with a mean age of 63 years range, years. Ten aneurysms were ruptured and 9 were incidentally or coincidentally found. Initial clinical and angiographic outcomes were retrospectively evaluated. The institutional review board approved this retrospective study with a waiver of patient informed consents. This balloon catheter has 3 markers: a distal catheter tip marker and 2 proximal and distal balloon markers.

The distance between the distal end of the balloon and the distal catheter tip marker is 5 mm in length. Another important characteristic of the Scepter balloon catheter is that the 5 mm-length distal tip allows for steam shaping, which makes it easier to track the microguidewire in a tortuous artery that has acute angulations and prevents blood reflux into the balloon.

The currently available balloon catheters' features are summarized and compared in the Table 1. All procedures, but one, were performed under general anesthesia. After placing a guiding catheter Shuttle 6 Fr, Cook or Envoy 6 Fr, Coddman Neurovascular in the cervical portion of the internal carotid or vertebral artery, the Scepter balloon catheter, with or without steam shaping of its distal tip, was navigated across the aneurysm neck at the distal portion using a 0.

After confirming that the balloon position spanned the entire aneurysm neck, the microguidewire was removed and the balloon catheter lumen for microguidewire insertion was continuously flushed with a pressurized heparinized solution during the procedure. In the case of removing the guidewire to unfix the balloon position, the guidewire was reinserted and maintained in position. The aneurysm sac was selected with another microcatheter Excelsior, Stryker, Fremont, CA, USA and the balloon-assisted coil embolization was performed.

If needed for bifurcation aneurysms Acom, MCA, or BA , the balloon was repositioned to the other branch that was not initially selected with the Scepter balloon catheter, using a 0. Procedural success was defined as complete occlusion or residual neck of the aneurysm sac on final control angiogram as classified according to Raymond classification 2.


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Advancement of Scepter balloon catheter over 0. Scepter balloon-assisted coil embolization performed after removal of microguidewire. Coil tail white arrowhead protruded after balloon deflation. Scepter balloon catheter is repositioned from right A2 to left A2 using microguidewire and is used to push coil tail in sac. Final control angiogram shows complete occlusion of aneurysm sac without any coil loop protrusion. Note that white arrow indicates distal tip marker of Scepter balloon catheter and black arrows indicate proximal and distal markers of balloon itself.

Characteristics of patients, aneurysms, and immediate post-treatment angiographic outcomes are summarized in Table 2. For one patient, a thrombus formation was detected at the neck portion of the ruptured MCA bifurcation aneurysm towards the end of the procedure. At discharge, functional neurological state improved in 11 patients 10 patients with a ruptured aneurysm and 1 with mass symptoms and the remaining 6 patients with unruptured aneurysm showed no newly developed symptoms Table 2.

Three-dimension reconstruction angiogram reveals large aneurysm at middle left cerebral artery bifurcation. Note that superior branch is incorporated into sac. After placement of balloon across aneurysm neck, gradual over-inflation causes substantial portion of balloon to herniate into aneurysm sac. At end of procedure, small thrombus black arrowhead is detected at aneurysm neck, close to origin of superior branch. After intraarterial infusion of Glycoprotein inhibitor, minutes follow-up angiogram shows resolution of thrombus and complete occlusion of aneurysm sac.

An angiography revealed a small, wide-necked aneurysm at the Acom. Under general anesthesia, a shuttle 6 Fr-guiding catheter was placed in the cervical ICA. First, a 0. The microguidewire was positioned further to the right A2 portion and the balloon catheter was placed, thus, spanning the entire aneurysm neck, and then, the balloon-assisted coil embolization was performed Fig. Near the end of the coil embolization, a coil tail protruded the Acom after balloon deflation Fig. The balloon catheter was re-positioned to the left A2 using a reintroduced microguidewire. Inflation of the balloon pushed the protruded coil tail into the aneurysm sac Fig.

A final control angiogram showed complete occlusions of the aneurysm sac Fig.

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An angiography showed a large aneurysm at the left MCA bifurcation. A three-dimensional reconstruction of the angiogram revealed that a superior branch was incorporated into the sac Fig.

FEATURE SUMMARY

After placement of the Scepter-C balloon catheter from the M1 to MCA inferior division, a gradual over-inflation of the balloon indicated that a substantial portion of the balloon was herniated into the sac Fig. At the end of the procedure, an angiography revealed a thrombus formation at the aneurysm neck close to the origin of the superior branch Fig. The patient showed no neurological deficit post-treatment. A three-dimensional reconstruction of the angiogram showed a large aneurysm on the left MCA bifurcation and another very small aneurysm close to the bifurcation aneurysm neck at the superior branch Fig.

After repositioning the balloon catheter, a very small aneurysm at the superior division was also embolized. The final control angiogram revealed a complete occlusion of both aneurysms and well-preserved MCA superior and inferior divisions Fig. Three-dimensional reconstruction angiogram reveals large aneurysm at middle left cerebral artery bifurcation and another very small aneurysm white arrowhead close to aneurysm neck at superior branch.

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After positioning Scepter balloon catheter across aneurysm neck, gradual over-inflation leads to herniation of central portion of balloon into large aneurysm sac. After balloon-assisted coil embolization of both aneurysms, final control angiogram shows complete occlusion of both aneurysms and well-preserved superior and inferior divisions. Black arrows indicate proximal and distal balloon markers of Scepter balloon catheter. White arrow indicated distal tip marker of Scepter balloon catheter black arrows, proximal and distal balloon markers; white arrow, tip marker of balloon catheter.

Stents have an inherent limitation in that they may induce in-stent thrombosis and may potentially increase thromboembolic complications. Such drawbacks lead to increased procedure-related morbidity and mortality rates in stent-assisted coiling relative to simple coiling 7 , 8. On the other hand, according to a few reports, procedure-related complications are significantly higher when using a balloon-assisted technique as compared to the conventional single-catheter technique 9.

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However, in a meta-analysis and recent prospective trials, the balloon-assisted technique did not significantly increase peri-procedural morbidity and mortality rates 10 , Until recently, at our institution, only the single-lumen balloon catheter has been available for coil embolization, which requires a balloon-specific 0. In contrast, the new double-lumen Scepter balloon catheter allows for any type of 0.

Furthermore, because of the 0.

In representative case 1, a coil tail protruded towards the A2, which was not covered by prepositioned Scepter balloon, after the balloon deflated towards the end of embolization. It has been an occasionally experienced limitation inherented to balloon-assisted coiling.

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In order to push the protruded coil, the repositioning of the balloon to the other branch in which the balloon was not initially positioned is necessary. Owing to its superior controllability, a 0. First case report on the Scepter C balloon catheter usage documented that all types of 0. A recent case series mentioned that the Scepter C balloon catheter was only navigated in one of the 52 aneurysms at various locations, and only one adverse event 1.

An additional advantage is that the Scepter balloon catheter has a 5 mm-length soft distal catheter tip that permits steam shaping.