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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 26:1232-1236, May 2005
© 2005 American Society of Neuroradiology

INTERVENTIONAL

Aneurysmal Pressure Changes with Nondetachable Balloon Placement and Fluid Infusion: Rationale for Liquid Embolization

Steven G. Imbesi^a, Kimberly Knox^a and Charles W. Kerber^a

^a From the Department of Radiology, University of California, San Diego Medical Center

Address reprint requests to Steven G. Imbesi, MD, Associate Professor of Radiology and Neurosurgery, Department of Radiology, University of California, San Diego Medical Center, 200 West Arbor Drive, Mail Code 8756, San Diego, CA 92103

BACKGROUND AND PURPOSE:To improve the safety and efficacy of liquid embolization, we evaluated changes in pressures in experimental aneurysms.

METHODS:We created three replicas of a lateral sidewall aneurysm and placed them in a physiologic flow circuit. A 3 x 10-mm nondetachable balloon was positioned in the parent vessel across the aneurysmal neck. Intra-aneurysmal pressures were measured at baseline and after balloon inflation. Fluid was infused into the sac via a 1.45F microcatheter during inflation, and maximal pressures were noted. Measurements were repeated eight times in each aneurysm.

RESULTS: After balloon inflation, average intra-aneurysmal pressures increased: 12 mm Hg (13%, _{n – 1} = 0.46) for aneurysm 1 (baseline mean arterial pressure [MAP], 94 mm Hg), 15 mm Hg (58%, _{n – 1} = 0.88) for aneurysm 2 (baseline MAP, 26 mm Hg), and 15 mm Hg (58%, _{n – 1} = 0.92) for aneurysm 3 (baseline MAP, 26 mm Hg). During inflation and infusion, pressures increased slightly: 1.1 (0.94%, _{n – 1} = 0.64), 1.6 (3.9%, _{n – 1} = 1.1), and 1.9 (4.6%, _{n – 1} = 1.2) mm Hg for aneurysms 1, 2, and 3, respectively. Despite complete balloon occlusion of the distal aneurysmal neck, a channel between the proximal aneurysmal neck and the parent-vessel lumen persisted along the microcatheter. Fluid exited the sac via this channel, preventing a concomitant, significant increase in pressure during infusion.

CONCLUSION: Intra-aneurysmal pressure modestly increased with inflation of a parent-vessel balloon across the neck. When liquid was infused into the sac during inflation, further increases were minimal.