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E-249 Use of the scepter mini in management of cerebrovascular malformations: a single-center experience and review of indications
  1. A Devarajan1,
  2. J Zhang1,
  3. D Goldman2,
  4. M Al-Kawaz1,
  5. H Tabani1,
  6. C Rossitto1,
  7. R De Leacy1,
  8. C Kellner1,
  9. A Berenstein1,
  10. J Fifi1,
  11. T Shigematsu1
  1. 1Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  2. 2Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA


Introduction Balloon assistance has been utilized to enhance the efficacy of endovascular embolization of cerebrovascular malformations. Recently, the advent of dual-lumen balloon catheters (DLBC) has allowed for simultaneous flow arrest and the injection of liquid embolic agents (LEA) for embolization without reflux or the creation of a proximal plug. To maximize safety and efficacy in embolization, the balloon should be placed as close as possible to the target pathology. The Scepter Mini is a new dual-lumen microballoon catheter which offers a softer balloon and smaller diameter than previous DLBCs to catheterize small-caliber distal intracranial vasculature. Here, we report on our institution’s experience with the Scepter Mini microcatheter.

Methods A single-center retrospective chart review identified all patients with cerebrovascular cerebrovascular pathology (dural arteriovenous fistulas, Vein of Galen Malformations, arteriovenous malformations, intracranial aneurysms, subdural hematomas, and tumor embolizations) treated with the Scepter Mini. Clinical data, structural and hemodynamic characteristics of the pathology, and technical parameters including anatomic approach, LEA used, complications and embolization success were reviewed.

Results 110 Scepter Mini microcatheters were used during 80 procedures in the treatment of 13 pediatric and 53 adult patients. The most common pathology treated with the Scepter Mini was dural arteriovenous fistulas (29/80 procedures). 75/80 procedures were performed by transarterial approach, and the Scepter Mini was used for embolization in all but one instance where it was used as balloon assistance for the coiling of a ruptured aneurysm. Technical success was achieved in 96.3% of all cases. Near-tip entrapment of the Scepter Mini occurred in 1/110 (0.9%) uses of the catheter, which was successfully retrieved without further complication. Clinical complications unrelated to the Scepter Mini occurred postoperatively in 8/80 cases and no intraoperative reflux or vessel rupture was noted.

Conclusion We report the largest cohort to date of Scepter Mini usage in the treatment of cerebrovascular malformations. The Scepter Mini is an important tool in the treatment of cerebrovascular pathology requiring extremely distal access and allows for the safe utilization of LEAs in high-flow pathology or small-caliber tortuous vasculature.

Disclosures A. Devarajan: None. J. Zhang: None. D. Goldman: None. M. Al-Kawaz: None. H. Tabani: None. C. Rossitto: None. R. De Leacy: None. C. Kellner: None. A. Berenstein: 2; C; Microvention. J. Fifi: 2; C; Microvention. T. Shigematsu: None.

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