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  • Initial experience with the Scepter Mini dual-lumen balloon for transophthalmic artery embolization of anterior cranial fossa dural arteriovenous fistulae

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New Devices and Techniques
Initial experience with the Scepter Mini dual-lumen balloon for transophthalmic artery embolization of anterior cranial fossa dural arteriovenous fistulae
  1. Benjamin Pulli1,
  2. Eric S Sussman2,
  3. Vera Mayercik1,
  4. Gary K Steinberg3,
  5. Huy M Do1,
  6. Jeremy J Heit4
  1. 1 Radiology, Neurointervention Division, Stanford University School of Medicine, Stanford, California, USA
  2. 2 Neurosurgery and Radiology, Stanford University School of Medicine, Stanford, California, USA
  3. 3 Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
  4. 4 Radiology, Neuroadiology and Neurointervention Division, Stanford University School of Medicine, Stanford, California, USA
  1. Correspondence to Dr Jeremy J Heit, Radiology, Neuroadiology and Neurointervention Division, Stanford University School of Medicine, Stanford, CA 94305, USA; jheit{at}stanford.edu

Abstract

Background Precise delivery of liquid embolic agents (LEAs) remains a challenge in the endovascular treatment of dural arteriovenous fistulae (dAVFs) and cerebral arteriovenous malformations (cAVMs). Despite significant advances in the past decade, LEA reflux and catheter navigability remain shortcomings of current endovascular technology, particularly in small and tortuous arteries. The Scepter Mini dual-lumen balloon microcatheter aims to address these issues by decreasing the distal catheter profile (1.6 French) while allowing for a small (2.2 mm diameter) balloon at its tip.

Methods We report our initial experience with the Scepter Mini in two patients with anterior cranial fossa dAVFs that were treated with transophthalmic artery embolization.

Results In both patients, the Scepter Mini catheter was able to be safely advanced into the distal ophthalmic artery close to the fistula site, and several centimeters past the origins of the central retinal and posterior ciliary arteries. A single Onyx injection without any reflux resulted in angiographic cure of the dAVF in both cases, and neither patient suffered any vision loss.

Conclusions These initial experiences suggest that the Scepter Mini represents a significant advance in the endovascular treatment of dAVFs and cAVMs and will allow for safer and more efficacious delivery of LEAs into smaller and more distal arteries while diminishing the risk of LEA reflux.

  • vascular malformation
  • liquid embolic material
  • catheter
  • balloon

https://doi.org/10.1136/neurintsurg-2020-016013

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    Footnotes

    • Twitter @JeremyHeitMDPHD

    • Contributors BP, ES, JH: design and conception of the work. BP: drafting of the manuscript. All authors: critical review and revision of the manuscript, interpretation of data of the work, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, and final approval of the version to be published.appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests JJH is a consultant for MicroVention, Inc. HMD is a consultant for MicroVention, Inc

    • Patient consent for publication Obtained.

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