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