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Original research
Balloon-assisted coil embolization and large stent delivery for cerebral aneurysms with a new generation of dual lumen balloons (Copernic 2L)
  1. Adrien Guenego1,2,
  2. Jean-Baptiste Zerlauth3,
  3. Francesco Puccinelli2,
  4. Steven Hajdu2,
  5. David C Rotzinger2,
  6. Felix Zibold4,
  7. Eike I Piechowiak4,
  8. Pasquale Mordasini4,
  9. Jan Gralla4,
  10. Tomas Dobrocky4,
  11. Roy T Daniel5,
  12. René Chapot6,
  13. Pascal J Mosimann2,4
  1. 1Department of Interventional and Diagnostic Neuroradiology, Toulouse University Hospital, Toulouse, France
  2. 2CHUV, Department of Interventional and Diagnostic Neuroradiology, University Hospital of Lausanne, Lausanne, Switzerland
  3. 3Institute of Diagnostic and Interventional Neuroradiology, Cecil - Hirslanden Clinic, Lausanne, Switzerland
  4. 4Department of Diagnostic and Interventional Neuroradiology, Inselspital - Bern University Hospital, Bern, Switzerland
  5. 5CHUV, Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland
  6. 6Department of Neurointerventional Therapy, Krupp Krankenhaus, Essen, Germany
  1. Correspondence to Dr Pascal J Mosimann, Inselspital, Neuroradiology, Freiburgstrasse 10, Sahli Haus 1, 3010 Bern, Switzerland; pascal.mosimann{at}insel.ch

Abstract

Introduction Dual 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 a parallel lumen design enabling enhanced inflation and deflation properties through which larger stents may be deployed, including flow diverters (FD).

Methods All aneurysms that were treated with a Copernic 2L (COP2L) dual lumen balloon catheter at our institution between February 2014 and December 2016 were assessed. Patient demographics, aneurysm characteristics, clinical and angiographic follow-up, as well as adverse events were analyzed.

Results A total of 18 aneurysms in 16 patients (14 women) were treated with the COP2L. Mean maximal aneurysm diameter was 6.4 mm, mean neck size was 3.3 mm (min 1; max 6.3), and mean aneurysm height/width was 1.1 (min 0.5; max 2.1). The COP2L was used for balloon-remodeled coiling exclusively in 2 aneurysms; coiling and FD stenting in 8; coiling and braided stent delivery in 3; coiling, braided and FD stenting in 1; and FD stenting without coiling in 4 (stenting alone). The rate of Roy–Raymond 1 (complete occlusion) changed from 22% in the immediate postoperative period to 100% at 3 months (mean imaging follow-up 8.2 months). There were three technical complications (3/16, 18.7%), including a perforation and two thromboembolic asymptomatic events that were rapidly controlled with the COP2L. There was no immediate or delayed morbidity or mortality (modified Rankin Scale score 0–1 in 100% of patients).

Conclusion The COP2L is a new type of dual lumen balloon catheter that may be useful for balloon and/or stent-assisted coiling of cerebral aneurysms. The same device can be used to deliver stents up to 4.5 mm and to optimize stent/wall apposition or serve as a life-saving tool in case of thromboembolic or hemorrhagic events. Long-term efficacy and safety need to be further assessed with larger case-controlled cohorts.

  • aneurysms
  • dual lumen balloon
  • large stent delivery
  • embolization
  • onyx

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Footnotes

  • Contributors Conception and design: PJM. Acquisition of data: PJM, FP, J-BZ, AG, SH. Analysis and interpretation of data: all authors. Drafting the article: AG and PJM. Critically revising the article: all authors. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: PJM.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AG, J-BZ, FP, SH, DCR, JG, PJM, TD, FZ, EIP, RC and RTD report no disclosures relevant to the manuscript. PJM was a consultant and proctor for Balt Extrusion at the time of the manuscript preparation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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