Double lumen remodeling balloon:

New technique for treatment of MCA

bifurcation aneurysm

Kadziolka K, Leautaud A., Estrade L., W. Mustafa,

Pierot L.

CHU REMIS

Interventional Neuroradiology Department

France

New technology

As medical technology advances

such as stenting, remodeling,

an increasing number of intracranial

aneurysms are being addressed for

EVT.

Aneurysm morphology

MCA large, bifurcation aneurysms are

technically challenging due to the complex

anatomy.

Bifurcation aneurysms are often wide necked

and incorporate the origin of arterial branches in the

aneurysm broad base.

Endovascular therapeutic

options

Remodeling with use of hyper compliant

balloon.

Double balloon technique ( kissing balloon)

Distal round balloon technique

Stent with or without balloon

„Y” stenting ( dual antiplatelet premedicatio )

Double lumen distal remodeling balloon?

Distal round balloon technique

v

Dual lumen balloon microcatheter

Primary experience with use of novel

double lumen balloon

ASCENT 4 x 7 mm

Micrus Endovascular Corp, San Jose, California, USA

Balloon Catheter Technical

Specification

Guidewire compatibility ≤.014”

Tip length distal to balloon 3 mm

Inner lumen diameter .0170”

Outer diameter 2.9F

Marker band 3 cm from distal tip allows delivery

of embolics (Ascent 4x7 mm)

Compatible with DMSO

Guiding catheter compatibility ,050” minimum ID

Patients and Methods

A 60-year-old male presented with

unruptured left MCA bifurcation aneurysm measuring 11×7 mm with neck 4 mm.

Dome to neck ratio 2.5.

Both parents suffered from ruptured

aneurysm subarachnoid hemorrhage.

Periprocedural Medication

Systemic heparinisation: 50 IU/kg bolus infusion

followed by 1500 IU/hour.

ASA 250 mg IV.

Systemic heparinisation prolonged for 24 hours.

Endovasculare procedure

Endovasculare procedure

Results

Results

Clinical outcome at discharge was unchanged.

Anatomic angiographic outcome appears as

residual neck.

Follow-up Examination

Follow up MRI after 3 months.

DSA follow-up at 6 months after the treatment

Follow-up Examination

Follow-up Examination

Anatomic angiographic outcome

appears as complete occlusion.

Embolisation of the aneurysm with dome to

neck diameter ≥ 6mm /3 mm distal

microcatheter tip/

Rigidity of the double lumen catheter

Cigar ellipsoidal shape instade of round more

spherical

Technical difficulties and limitations

Our recomendations for use of

Ascent double lumen balloon

New compliant guide catheters 6F or coaxial

guiding platform.

Microwire .014" rather then smaller

Conclusion

Double lumen balloon provides a means to

acheive reconstruction of complex mca

bifurfation aneurysm and can be an alternative

to double balloon(kissing)technique or “Y”

stenting for some selective bifurcation

aneurysms.

Due to development of new endovascular

devices treatment of mca bifurcation becomes

safer, feasible and durable.