Post-Doctoral Research Fellow University of Pennsylvania Department of Neurosurgery Alexandria, Egypt
Introduction: Distal catheter navigability and imprecise delivery of embolic agents remain as the two most important limitations encountered during endovascular liquid embolization of neurovascular malformations. The new dual-lumen Scepter-Mini Balloon (SMB) microcatheter was introduced with the aim of overcoming these limitations encountered with conventional microcatheters with few small single-center reports suggesting favorable results; however, multicenter data remain lacking.
Methods: Series of consecutive patients undergoing endovascular embolization utilizing SMB were extracted from prospectively maintained registries at 7 North American cerebrovascular centers (November 2019- December 2021).
Results: 55 patients undergoing embolization utilizing the SMB were included (median age 58.5; 56.4% females). Cranial dural arteriovenous fistula (dAVF) embolization was the most common indication (54.5%) followed by cranial arteriovenous malformation (AVM) embolization (21.8%). Staged/pre-operative embolization was done in 23.6% of the cases, with 92.7% of procedures utilizing Onyx-18 as embolic agent. The majority of procedures utilized transarterial approach (89.1%), while arterial flow arrest utilizing Scepter-Mini concurrently with transvenous embolization was utilized in 7.3% of procedures. Femoral access and triaxial setups were utilized in most procedures (85.5% and 60%, respectively). The median vessel diameter where balloon was inflated of 1.7mm, with a median 1.5cc of injected embolic material per procedure. Technical failures were encountered in 7.3% of procedures requiring replacement with other microcatheters without clinical sequelae in any of the patients, with SMB-related procedural complications of 1.8%. Complete occlusion (100%) or >50% occlusion on last follow-up were documented in 78.2% of the cases, with unplanned retreatments needed in 1.8% of the cases, over a median of 3.7 months of follow-up.
Conclusion : The Scepter-Mini Balloon microcatheter is a useful new adjunctive device for balloon-assisted embolization of cerebrospinal neurovascular malformations requiring distal access with a high technical success rate, favorable outcomes, and reasonable safety profile.
