Tools and techniques
Dual lumen balloon catheter – An effective substitute for two single lumen catheters in treatment of vascular targets with challenging anatomy

https://doi.org/10.1016/j.jocn.2018.01.070Get rights and content

Highlights

  • Clinical significance of use of dual lumen balloon catheters.

  • Treatment of wide range of pathological vascular conditions of the brain and spine.

  • Safe use of those devices even in blood vessels with very small diameter.

  • Safe treatment of vascular target with challenging anatomy.

  • Differences between dual lumen balloon catheters and single lumen balloons and catheters.

Abstract

The aim of this study was to describe our experience in the treatment of various pathological conditions of the cranial and spinal blood vessels and hypervascularized lesions using dual lumen balloon catheters. Twenty-five patients were treated with endovascular techniques: two with vasospasm of cerebral blood vessels caused by subarachnoid hemorrhage, one with a hypervascularized metastasis in the vertebral body, two with spinal dural fistula, four with cerebral dural fistula, three with cerebral arteriovenous malformations, and 13 with aneurysms. The dual lumen balloon catheters were used for remodeling of the coil mesh, injection of various liquid embolic agents, particles and nimodipine, for the prevention of reflux and deployment of coils and stents. The diameter of catheterized blood vessels varied from 0.7 mm to 4 mm. Two complications occurred: perforation of an aneurysm in one case and gluing of the tip of balloon catheter by embolic material in another case. All other interventions were uneventful, and therapeutic goals were achieved in all cases except in the case with gluing of the tip of balloon catheter. The balloons effectively prevented reflux regardless of the type of the embolic material and diameter of blood vessel. The results of our study show that dual lumen balloon catheters allow complex interventions in the narrow cerebral and spinal blood vessels where the safe use of two single lumen catheters is either limited or impossible.

Introduction

Various embolic materials are used for occlusion of aneurysms, arteriovenous malformations and fistulas as well as for devascularization of hypervascularized tumors. All these materials are injected through microcatheters placed in the aneurysms or in the arteries feeding the arteriovenous malformations [AVM], arteriovenous fistulas or hypervascularized tumors. There are three goals of endovascular treatment of these structures: to fill them with embolic material, to protect or to restore the flow in the affected blood vessel and to avoid unwanted embolization. The first balloon technique developed to remodel the coil mesh and temporarily protect the flow in parent artery harboring a wide-necked aneurysm was described by Moret et al. in 1997 [1]. The permanent protection of a parent artery harboring a very wide-necked aneurysm was achieved for the first time in early 2000s by a specially designed, self-expandable stent deployed in the artery in front of the aneurysm [2]. A more difficult problem was prevention of the reflux of liquid embolic agents [LEA] along the microcatheter and subsequent unwanted embolization of side-branches when treating an AVM or a fistula. Creation of the plug of an embolic material [Onyx, for example] at the tip of the microcatheter in order to direct the flow of this material toward the AVM or fistula is sometimes a very difficult task with uncertain outcome due to aggressive reflux, prolongation of the intervention with subsequent precipitation of the embolic material and only partial occlusion of the AVM or fistula [3]. Several techniques have been developed to overcome these problems. Two recently described techniques are based on simultaneous utilization of two microcatheters [3], [4], while several others are based on the utilization of dual lumen balloon catheters [DLBC] [5], [6], [7], [8]. We have recently begun to use a DLBC to facilitate delivery of embolic material and prevent undesired reflux.

The aim of this review was to demonstrate the applicability of dual lumen catheters in treatment of a wide spectrum of pathological vascular conditions in the brain and spine and to describe our experience in using these devices.

Section snippets

Material and methods

The DLBCs are standard neurointerventional tools, and since 2010 we have used a total of 299 DLBCs in various neurointerventional procedures. In 25 cases treated for various pathological vascular conditions of the brain and spine, the DLBCs were used as dual-purpose devices. Thirteen patients were treated for cerebral aneurysms [seven for ruptured and six for unruptured ones], three for cerebral AVMs, six for fistulas [three for cranial dural fistulas, two for spinal dural fistulas and one for

Results

All results are summarized in the Table 1.

The goal of the treatment was achieved in all cases except in the case of a left-sided frontal AVM with a nidus containing an intranidal aneurysm. In this case only a part of the nidus and aneurysm were embolized. All saccular aneurysms were embolized with a satisfactory degree of occlusion corresponding to grade I in eight cases, grade II in one case and grade III in two cases, according to the modified Raymond-Ray scale. Two dissected arteries were

Discussion

The remodeling technique introduced and developed by Moret and co-workers, i.e., simultaneous use of a single lumen balloon catheter and a single lumen microcatheter, enabled denser packing of the aneurysm with coils and a more stable microcatheter during coil deployment, resulting in lowered rate of recanalization of aneurysms and reduced number of complications caused by protrusion of coil mesh from the aneurysm into the parent artery [10], [11], [12]. We have used dual lumen balloons in 299

Conclusion

The DLBC may be briefly described as two endovascular devices coupled in one. Thanks to this feature, the DLBC can be used either as a balloon or as a catheter or as both simultaneously. The result of this study showed that it was possible to perform successfully complex interventions in relatively narrow blood vessels when using the DLBC and that the number, severity and outcomes of complications appeared acceptable, considering that all cases in our series were challenging. Improvement of the

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