1024-77 Comparison of Immediate and Mid-term Results Following Percutaneous Mitral Commissurotomy with the Inoue Stepwise Technique and with the Double-Balloon Technique

Introduction: Percutaneous mitral commissurotomy (PMC) using either the Inoue or the double balloon technique showed similar, excellent 7-year outcomes, but very late results after successful PMC have been unknown. Hypothesis: We assessed late results of PMC up to 20 years in a randomized trial comparing Inoue versus double-balloon technique. Methods: Between 1989 and 1995, a total of 302 patients (77 men, 41±11 years) with severe mitral stenosis were randomly assigned to undergo PMC using Inoue (n=152; group I) or double-balloon technique (n=150; group D). The end points were the composite clinical events of death, mitral surgery, repeat PMC, or deterioration of NYHA class ≥3 that occurred after enrollment. Results: The successful immediate results [post-PMC mitral valve area (MVA) ≥1.5 cm 2 and mitral regurgitation (MR) grade ≤2] were achieved in 127 (84%) patients of group I and 122 (81%) patients of group D (p= NS). During median follow-up of 20.7 years (IQR, 18.9 to 22.9), clinical events occurred in 82 (53.9%) patients of group I (37 deaths, 44 mitral surgeries, 9 repeat PMCs and 3 NYHA class ≥3) and 79 (52.7%) patients of group I (34 deaths, 51 mitral surgeries, 5 repeat PMCs and 4 NYHA class ≥3). The event-free survival rates were not significantly different between group I and group D (49.3% and 55.3% at 20 years, respectively; HR, 1.22; 95% CI, 0.88-1.70; p=0.23) (Figure). On multivariate Cox analysis, absence of commissural MR (HR, 1.75; 95% CI, 1.22-2.51; p=0.002), immediate post-PMC MVA <1.8cm 2 (HR, 1.54; 95% CI, 1.04-2.27; p=0.03), and atrial fibrillation (HR, 1.53; 95% CI, 1.04-2.23; p=0.03) were independently related with clinical events after successful PMC. Conclusions: In this randomized trial, the Inoue and double-balloon methods showed similar, good outcomes up to 20 years, and the achievement of effective commissurotomy with development of commissural MR or immediate post-PMC MVA ≥1.8cm 2 is important in optimizing the late results of PMC.

Download Full-text

Subclavian artery angioplasty for the treatment of angina using a double balloon technique to protect a left internal mammary artery graft

European Radiology ◽

10.1007/s003300101000 ◽

2001 ◽

Vol 12 (4) ◽

pp. 908-910 ◽

Cited By ~ 3

Author(s):

Richard D. Jones ◽

Raman Uberoi

Keyword(s):

Subclavian Artery ◽

Internal Mammary Artery ◽

Left Internal Mammary Artery ◽

Double Balloon ◽

Artery Graft ◽

Internal Mammary Artery Graft ◽

Internal Mammary ◽

Balloon Technique

Download Full-text

Embolization of direct carotid cavernous fistulas with the novel double-balloon technique

Interventional Neuroradiology ◽

10.1177/1591019915609779 ◽

2015 ◽

Vol 22 (2) ◽

pp. 201-205 ◽

Cited By ~ 4

Author(s):

Yin Niu ◽

Lin Li ◽

Jun Tang ◽

Gang Zhu ◽

Zhi Chen

Keyword(s):

Transarterial Embolization ◽

The Novel ◽

Cerebral Vascular Disease ◽

Safety And Efficacy ◽

Double Balloon ◽

Recurrent Fistula ◽

Balloon Technique ◽

Carotid Cavernous Fistulas ◽

Prospective Database

Multiple endovascular management of direct carotid cavernous fistula (CCF) has been widely accepted as a treatment option. Embolization of the fistula with detachable balloons or thrombogenic coil-based occlusion has been the main choice to treat direct CCF, with good safety and efficacy. This study investigated the safety and efficacy of embolization of direct CCF with the novel double-balloon technique. A retrospective review of a prospective database on cerebral vascular disease was performed. We identified a total of five patients presenting with high-flow direct CCF. All patients were managed with transarterial embolization with the novel double-balloon technique. Three of the five patients were treated with two detachable balloons, and a completely occluded fistula with preservation of the internal carotid artery was achieved. Of the remaining two patients treated with more detachable balloons, one patient achieved a perfect outcome and the other one suffered from recurrent fistula due to balloon migration 3 weeks after embolization. During a follow-up period of 12–18 months, no symptoms reoccurred in any patient. Thus, the double-balloon treatment may be a promising method for CCF complete occlusion. This novel technique may bring more benefits in the following two cases: 1). A single inflated detachable balloon fails to completely occlude the CCF, which causing the next balloon can not pass into the fistula. 2). A giant CCF needs more balloons for fistula embolization.

Download Full-text

European Experiences with Push-and-Pull Enteroscopy in Double-Balloon Technique (Double-Balloon Enteroscopy)

Gastrointestinal Endoscopy Clinics of North America ◽

10.1016/j.giec.2006.01.016 ◽

2006 ◽

Vol 16 (2) ◽

pp. 377-382 ◽

Cited By ~ 11

Author(s):

Andrea May ◽

Christian Ell

Keyword(s):

Double Balloon Enteroscopy ◽

Balloon Enteroscopy ◽

Double Balloon ◽

Balloon Technique ◽

Push And Pull

Download Full-text

Detachable balloon embolization as the preferred treatment option for traumatic carotid-cavernous sinus fistula?

Interventional Neuroradiology ◽

10.1177/1591019919871849 ◽

2019 ◽

Vol 26 (1) ◽

pp. 90-98

Author(s):

Yin Niu ◽

Tunan Chen ◽

Jun Tang ◽

ZhouYang Jiang ◽

Gang Zhu ◽

...

Keyword(s):

Cavernous Sinus ◽

Coil Embolization ◽

Treatment Options ◽

Detachable Balloon ◽

Double Balloon ◽

Carotid Cavernous Sinus Fistula ◽

Balloon Technique ◽

Glue Embolization ◽

Balloon Embolization

Objective The purpose of the study was to investigate the treatments and outcomes of patients with traumatic carotid-cavernous sinus fistula (TCCF). Methods All patients diagnosed with TCCF at our institution from January 2013 to December 2018 and meeting the inclusion/exclusion criteria were included in the study. Results A total of 24 patients were included in this study. Of them, 21 (87.5%) were treated with detachable balloon embolization, 1 (4%) with coil embolization, 1 (4%) with balloon-assisted coil embolization, and 1 (4%) with balloon-assisted coil and glue embolization. Among the 21 patients treated with detachable balloon embolization, 10 underwent double-balloon technique embolization including double-detachable balloon embolization (n = 6) and balloon-assisted detachable balloon embolization (n = 4). The fistulas in 17 patients (17/21, 81%) were successfully occluded after the first attempt of detachable balloon embolization, while those in the remaining 4 patients were occluded after a second surgery due to TCCF recurrence or pseudoaneurysm development. Preservation of the internal carotid artery (ICA) was observed in 19 cases after the first treatment by detachable balloon embolization (19/21, 90.4%). ICA was occluded in the remaining two patients, as revealed by a complete angiographic evaluation of the circle of Willis. All patients achieved complete resolution of ocular and orbital manifestations as well as pulsatile bruit, except for three patients whose oculomotorius and/or abducens remained paralyzed during the follow-up period. Conclusion Although several endovascular treatment options are available for TCCF, the detachable balloon embolization is still the preferred method of TCCF, as evidenced in our study. Furthermore, double balloon technique, an improvement upon the conventional detachable balloon embolization, is extremely safe and can effectively treat patients with refractory TCCF.

Download Full-text