First clinical multicenter experience with the new Scepter Mini microballoon catheter

2020 ◽  
pp. neurintsurg-2020-016115 ◽  
Author(s):  
Dominik F Vollherbst ◽  
René Chapot ◽  
Marta Wallocha ◽  
Isil Saatci ◽  
Saruhan Cekirge ◽  
...  
Keyword(s):  
Vascular Malformations ◽  
Balloon Occlusion ◽  
Cerebral Arteriovenous Malformations ◽  
Balloon Inflation ◽  
New Device ◽  
Spinal Vascular Malformations ◽  
Navigation Support ◽  
Diagnostic Angiography ◽  
The Mean ◽  
Technical Failures

BackgroundBalloon-assisted techniques can improve the endovascular treatment of cerebrospinal vascular malformations. The aim of this study was to report the first clinical multicenter experience with the new Scepter Mini dual-lumen microballoon catheter.MethodsPatients with cerebral or spinal vascular malformations treated with the Scepter Mini at seven European neurovascular centers were retrospectively reviewed. Clinical data, angiographic features of the vascular malformations, procedural parameters including the type of application, navigability, technical failures, complications and embolization success were assessed.ResultsThe usage of 34 Scepter Mini microballoon catheters in 20 patients was analyzed. Most treated malformations (80.0%) were cerebral arteriovenous malformations. Four different applications were reported: embolization via Scepter Mini (n=23, 67.6%), balloon-occlusion with simultaneous embolization via a second microcatheter (n=3, 8.8%), diagnostic angiography with simultaneous balloon-inflation for flow arrest (n=4, 11.8%), and navigation support (n=4, 11.8%). The mean diameter of the blood vessels in which the Scepter Mini was inflated was 1.9±0.5 mm. The navigability of the Scepter Mini was rated as ‘easy’ or ‘very easy’ in 88.2% of cases. Complete occlusion of the malformation was achieved in 60.9% of cases. Technical failures occurred in 4/23 embolization procedures, and all were related to insufficient stability of the balloon within the vessel. No complications related to the Scepter Mini were observed, while unrelated complications occurred in three patients (15.0%).ConclusionsThe Scepter Mini is a promising new device for balloon-assisted embolization of cerebrospinal vascular malformations via small feeders. Beyond embolization, the Scepter Mini can also be used for other applications, such as superselective flow arrest and navigation support.

Abstract 6119: Ultrasound 2D Speckle Tracking Differentiates Stunned from Scarred Myocardium after Acute MI

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Susanna Prat-Gonzalez ◽  
Gonzalo Pizarro ◽  
Babu A. Benson ◽  
Borja Ibanez ◽  
Giovanni Cimmino ◽  
...  
Keyword(s):  
Speckle Tracking ◽  
Radial Strain ◽  
Balloon Occlusion ◽  
Normal Myocardium ◽  
Stunned Myocardium ◽  
Gradient Echo ◽  
Simple Tool ◽  
2D Speckle Tracking ◽  
Acute Mi ◽  
The Mean

Background: The aim of this study was to evaluate 2D Speckle Tracking radial strain by ultrasound in stunned and scarred myocardium as defined by cardiac magnetic resonance (CMR) in a porcine reperfusion model of acute MI. Methods: Seven pigs underwent MI induction by 90′ mid-LAD balloon occlusion. CMR was performed in a 1.5 T magnet 4 days post-MI. For edema imaging a T2-weighted sequence was employed. Delayed enhancement (DE) images were acquired 10–15 minutes after the administration of 0.2 mmol/kg of Gd-DTPA using an inversion recovery gradient-echo sequence. Before CMR, echocardiographic short axis images of the LV were obtained at the basal, mid and apical levels. Echo and CMR images were matched and divided into 6 segments per slice. DE and edema were defined as those regions with signal intensity >3 SD of the mean signal of remote normal myocardium, and quantified as % of the LV. Stunned myocardium was defined as edema- DE. Radial strain was compared in segments containing predominantly normal myocardium (<10% edema; n=70), stunned myocardium [>25% (edema - DE); n=12] or predominantly scar (>75 % DE; n=19). Results: A total of 126 segments were analyzed. Radial strain was negatively correlated with the amount of edema (r=−0.41) and scar (r=−0.39, p<0.0001 for both). Radial strain was significantly lower in necrotic than in normal segments (p<0.001). Stunned segments showed intermediate degrees of myocardial deformation. (Figure ) Conclusions: Our study suggests that 2D Speckle Tracking radial strain can be a simple tool to differentiate stunned from scarred segments. This could be particularly useful in unstable patients after acute MI.

scholarly journals Clinical and angioarchitectural characteristics of spinal vascular malformations of the cervical spine

2020 ◽  
Vol 32 (5) ◽  
pp. 755-762 ◽  
Author(s):  
Waleed Brinjikji ◽  
Elisa Colombo ◽  
Giuseppe Lanzino
Keyword(s):  
Cervical Spine ◽  
Lower Extremity ◽  
Clinical Presentation ◽  
Vascular Malformations ◽  
Case Series ◽  
Acute Onset ◽  
Lower Extremity Weakness ◽  
Arteriovenous Fistulas ◽  
Spinal Vascular Malformations ◽  
Interventional Neuroradiologist

OBJECTIVEVascular malformations of the cervical spine are exceedingly rare. To date there have been no large case series describing the clinical presentation and angioarchitectural characteristics of cervical spine vascular malformations. The authors report their institutional case series on cervical spine vascular malformations diagnosed and treated at their institution.METHODSThe authors retrospectively reviewed all patients with spinal vascular malformations from their institution from January 2001 to December 2018. Patients with vascular malformations of the cervical spine were included. Lesions were characterized by their angioarchitectural characteristics by an interventional neuroradiologist and endovascular neurosurgeon. Data were collected on clinical presentation, imaging findings, treatment outcomes, and long-term follow-up. Descriptive statistics are reported.RESULTSOf a total of 213 patients with spinal vascular malformations, 27 (12.7%) had vascular malformations in the cervical spine. The mean patient age was 46.1 ± 21.9 years and 16 (59.3%) were male. The most common presentations were lower-extremity weakness (13 patients, 48.1%), tetraparesis (8 patients, 29.6%), and lower-extremity sensory dysfunction (7 patients, 25.9%). Nine patients (33.3%) presented with hemorrhage. Fifteen patients (55.6%) had modified Rankin Scale scores of 0–2 at the time of diagnosis. Regarding angioarchitectural characteristics, 8 patients (29.6%) had intramedullary arteriovenous malformations (AVMs), 5 (18.5%) had epidural arteriovenous fistulas (AVFs), 4 (14.8%) had paraspinal fistulas, 4 (14.8%) had mixed epidural/intradural fistulas, 3 (11.1%) had perimedullary AVMs, 2 (7.4%) had dural fistulas, and 1 patient (3.7%) had a perimedullary AVF.CONCLUSIONSThis retrospective study of 27 patients with cervical spine vascular malformations is the largest series to date on these lesions. The authors found substantial angioarchitectural heterogeneity with the most common types being intramedullary AVMs followed by epidural AVFs, paraspinal fistulas, and mixed intradural/extradural fistulas. Angioarchitecture dictated the clinical presentation as intradural shunts were more likely to present with hemorrhage and acute onset myelopathy, while dural and extradural shunts presented as either incidental lesions or gradually progressive congestive myelopathy.

Assessment of Complication Types and Rates Related to Diagnostic Angiography and Interventional Neuroradiologic Procedures

1998 ◽  
Vol 4 (1) ◽  
pp. 27-37 ◽  
Author(s):  
M.B. Horowitz ◽  
K. Dutton ◽  
P.D. Purdy
Keyword(s):  
Complication Rate ◽  
Interventional Procedures ◽  
Daily Basis ◽  
Balloon Occlusion ◽  
Neurologic Complication ◽  
Puncture Site ◽  
Full Spectrum ◽  
Vessel Injury ◽  
Diagnostic Angiography ◽  
Individual Complication

We determined the types and rates of complications related to diagnostic angiography and neuroradiologic interventional procedures at a centre that carries out the full spectrum of angiographic procedures. The occurrence of immediate and delayed complications in 1929 neuroangiographic procedures (1358 diagnostic and 571 interventional) performed between the years 1993–1996 was prospectively identified and recorded on a daily basis. A retrospective review of all charts of patients having procedures conducted during the study period was also carried out to ensure that no complications were missed. The overall complication rate for diagnostic cerebral angiography was 2.2%. Puncture site complications ranged from 0 – 0.1%. Vessel injury distal to the puncture site ranged from 0.2 – 0.6%. The temporary neurologic complication rate was 0.3%, while the permanent rate was 0.4%. There were no contrast reactions. The death rate was 0.1%. Interventional procedures had higher incidences of complications with overall rates ranging from 5.3 – 33%. Temporary and permanent neurologic deficits occurred at a rate of 0 – 10.5% depending upon the procedure involved. Individual complication and death rates and complication categories are provided for arteriovenous malformation embolisation, tumour embolisation, temporary balloon occlusion tests, detachable balloon vessel sacrifice, urokinase infusion, angioplasty, papavarine infusion, GDC embolisation, and carotid cavernous fistula embolisation. When carried out in experienced hands, neuroangiography and neurointervention are relatively safe with low incidences of neurologic and non-neurologic complications. Knowledge of these rates is important when counselling patients prior to treatments or deciding upon the risk-benefit ratio of preoperative procedures.

Abstract P141: Electrocardiogram Waveform Analysis Reveals Probability of Return of Spontaneous Circulation in Both Swine and Human Subjects

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Lawrence D Sherman ◽  
James T Niemann ◽  
Thomas D Rea ◽  
John P Rosborough ◽  
James D Waters ◽  
...  
Keyword(s):  
Human Subjects ◽  
Area Under The Curve ◽  
Spontaneous Circulation ◽  
Balloon Occlusion ◽  
Waveform Analysis ◽  
Swine Model ◽  
Return Of Spontaneous Circulation ◽  
Percutaneous Balloon ◽  
Initial Shock ◽  
The Mean

Background: The Logarithm of the Absolute Correlations (LAC) is a measure which estimates VF duration based on the fractal dimension of the waveform. We hypothesized that the LAC measures the underlying physiology of the myocardium and would enable identification of those who would have return of spontaneous circulation (ROSC) in response to the initial shock. We tested this hypothesis in a swine model and among humans treated for out-of-hospital cardiac arrest Methods: 20 swine were placed in VF either by electrical stimulation (n=10) or through ischemia produced by percutaneous balloon occlusion of the left anterior descending artery (n=10). After 7 minutes of VF, CPR was performed for 1 min followed by defibrillation. Response to shock was recorded as ROSC if a BP of 60 mm Hg was present. The LAC was calculated for five second intervals during VF. In the human cohort, the AED ECG recordings of 165 subjects were analyzed. The average interval from 9 –1–1 call to EMS scene arrival was 5 minutes. Response to shock was recorded as ROSC if an organized rhythm corresponded with a palpable BP as determined by review of audio and written EMS report. The LAC was calculated on the 6 seconds of VF preceding the initial shock. In both the swine and human experience, we compared the mean LAC between those with and without ROSC. We calculated receiver operating characteristic (ROC) curves and measured the area under the curve to assess the diagnostic ability of the LAC. Results: In the swine model, the mean LAC differed significantly between swine with and without ROSC following the initial shock (with ROSC: 5.17±0.19 [n=6] versus without ROSC: 4.88±0.27 [n=14]: p = 0.033). The AUC for the LAC measure was 0.80. In the human cohort, the LAC also differed significantly between those with and without ROSC following the initial shock (5.21±0.34 [n=36] versus 4.81±0.47 [n=129], p < 0.0001). The AUC for the LAC measure was 0.76. Conclusions: The LAC measure predicts ROSC in both swine and human VF and can be used to guide resuscitation care. Swine ischemic VF is similar to that seen in humans.

SAFE BALLOON INFLATION PARAMETERS FOR RESUSCITATIVE ENDOVASCULAR BALLOON OCCLUSION OF THE AORTA

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Kaspars Maleckis ◽  
Courtney Keiser ◽  
Majid Jadidi ◽  
Eric Anttila ◽  
Anastasia Desyatova ◽  
...  
Keyword(s):  
Balloon Occlusion ◽  
Balloon Inflation ◽  
Endovascular Balloon Occlusion

Spinal Vascular Malformations

2011 ◽  
pp. 4167-4202 ◽  
Author(s):  
Aaron S. Dumont ◽  
Edward H. Oldfield
Keyword(s):  
Vascular Malformations ◽  
Spinal Vascular Malformations
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