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  • Extra-small dual-lumen micro-balloon catheters can improve endovascular embolization: an experimental in vivo and in vitro study

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Extra-small dual-lumen micro-balloon catheters can improve endovascular embolization: an experimental in vivo and in vitro study
  1. Dominik F Vollherbst1,2,
  2. Ruth Otto1,
  3. Thuy D Do2,
  4. Andreas von Deimling3,
  5. Hans U Kauczor2,
  6. Martin Bendszus1,
  7. Christof M Sommer2,4,
  8. Markus A Möhlenbruch1
  1. 1Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
  2. 2Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
  3. 3Department of Neuropathology, Heidelberg University Hospital, CCU Neuropathology, DKTK and DKFZ, Heidelberg, Germany
  4. 4Clinic for Diagnostic and Interventional Radiology, Klinikum Stuttgart, Stuttgart, Germany
  1. Correspondence to Markus A Möhlenbruch, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg 69120, Germany; markus.moehlenbruch{at}med.uni-heidelberg.de

Abstract

Background The embolization technique can have significant impact on the success of endovascular embolization.

Objective To evaluate the feasibility, embolization characteristics, and embolization extent with a newly developed extra-small micro-balloon catheter in an in vivo and in an in vitro embolization model in comparison with standard microcatheter embolizations.

Materials and methods Twenty-eight embolization procedures were performed in the porcine rete mirabile (RM) and in an in vitro embolization model, using either an extra-small (distal outer diameter 1.6 F) dual-lumen micro-balloon catheter or a standard microcatheter. Precipitating hydrophobic injectable liquid (PHIL) was used as embolic agent. Procedure times, number of injections, required volume of embolic agent, and embolization extent (percentage of embolized RM in postinterventional X-ray scans or number of filled sections of the in vitro model) were assessed. Histopathological analyses were performed.

Results Total procedure time was significantly shorter (in vivo: 123 s vs 615 s (medians), P=0.001; in vitro: 180 s vs 496 s (medians), P=0.001), number of reflux events was significantly lower (in vivo: 0 vs 9 (medians), P=0.001; in vitro: 0 vs 3 (medians), P=0.001), and embolization extent was significantly higher (in vivo: 96.9% vs 65.6% (medians), P=0.011; in vitro: 26 vs 18 filled sections (medians); P=0.041) for the micro-balloon catheter groups. There was antegrade movement of the PHIL cast after balloon deflation in one in vitro embolization procedure and spontaneous balloon deflation with subsequent reflux in one in vivo embolization procedure.

Conclusion Extra-small dual-lumen micro-balloon catheters can improve endovascular embolization in comparison with standard microcatheter embolization.

  • arteriovenous malformation
  • balloon
  • catheter
  • liquid embolic material
  • fistula

https://doi.org/10.1136/neurintsurg-2018-013752

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    Footnotes

    • Contributors All listed authors contributed to the work. DFV, CMS, and MAM acquired, analyzed, and interpreted data for the work; designed the study; drafted the manuscript and approved the final manuscript. RO, TDD, and AvD acquired, analyzed, and interpreted data for the work; drafted the manuscript and approved the final manuscript. HUK and MB analyzed and interpreted data for the work; drafted the manuscript and approved the final manuscript.

    • Funding The study was technically supported by MicroVention (Tustin, USA) without any influence on data acquisition, analysis and writing of the manuscript.

    • Competing interests DFV: has received travel support outside this work from MicroVention and Stryker GmbH & Co. KG; HUK: reports grants, personal fees and non-financial support from Siemens, personal fees from Boehringer Ingelheim, personal fees and non-financial support from Bayer, personal fees from GSK, personal fees from Novartis, personal fees from Astra Zeneca, personal fees from Philips, personal fees from Bracco, outside the submitted work. MB: reports board membership: DSMB Vascular Dynamics; consultancy: Roche, Guerbet, Codman; grants/grants pending: DFG, Hopp Foundation, Novartis, Siemens, Guerbet, Stryker, Covidien; payment for lectures (including service on speakers bureaus): Novartis, Roche, Guerbet, Teva, Bayer, Codman; MAM: has received consulting honoraria, speaker honoraria, and travel support outside this work from Codman, Covidien/Medtronic, MicroVention, Phenox, and Stryker. All other authors have nothing to disclose.

    • Patient consent Not required.

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