scholarly journals Simulation Study of Distal Balloon Protection Systems during Carotid Artery Stenting

2004 ◽  
Vol 10 (2_suppl) ◽  
pp. 79-84
Author(s):  
T. Kuroiwa ◽  
N. Sakai ◽  
M. Sakaguchi ◽  
H. Adachi ◽  
H. Imamura ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid ◽  
Circulatory System ◽  
Optimal Placement ◽  
Simulation Studies ◽  
Distal Embolization ◽  
Simulation Experiments ◽  
Protection Systems ◽  
Particulate Debris ◽  
Balloon Protection

The purpose of our experimental study was to assess the pitfalls of distal balloon protection systems and to learn any technique tips to increase safety. Silicone carotid artery models were connected to a circulatory system to simulate arterial flow. A distal balloon protection device, PercuSurge GuardWire Plus (GWP, Medtronic Vascular) was delivered to the internal carotid artery (ICA), then was inflated to occlude ICA flow temporarily. A debris aspiration catheter (Export catheter) was delivered just proximal to the GuardWire Plus balloon coaxially, in order to introduce and diffuse particulate debris (200–500 micro meter in diameter) in the ICA stump. Then, after debris in the stump was aspirated, the GWP balloon was deflated. We recorded all the processes of our simulation experiments on a digital video and observed the movements of debris during these experiments. Exp 1) We simulated the movements of debris in the ICA stump when the GWP balloon was gradually deflated to produce a crevice between the balloon and vessel wall, simulating accidental movement of the GWP balloon during the procedure. Exp 2) In order to assess the optimal placement of the tip of aspiration catheter, the debris in the ICA stump was aspirated from three different sites (from just below the GuardWire balloon, from 2 cm below it, and from 5 cm below it). Exp 1) When the crevice appeared between GuardWire balloon and silicone tube, simulated debris began to concentrate just below the balloon. Then, some debris migrated distally from the crevice, and another part crowded in the crevice so that was impossible to aspirate and migrated in the end. Exp. 2) Debris aspiration was most effective from immediately below the GuardWire balloon, and the aspiration ability declined as the distance between the balloon and aspiration catheter became longer. According to our simulation studies, when the GWP balloon was moved accidentally during CAS procedures, or when the aspiration catheter was not delivered all the way to the GuardWire Plus balloon, distal embolization might still occur, even under protection.

Embolization of carotid-cavernous fistulas: A technical note on simultaneous balloon protection of the internal carotid artery

2020 ◽  
Vol 78 ◽  
pp. 389-392
Author(s):  
Hussein A. Zeineddine ◽  
Victor Lopez-Rivera ◽  
Christopher R. Conner ◽  
Faheem G. Sheriff ◽  
Phillip A. Choi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Technical Note ◽  
Carotid Cavernous Fistulas ◽  
Balloon Protection

scholarly journals Endovascular revascularization of symptomatic chronic total occlusions of the internal carotid artery using a proximal balloon protection device

2021 ◽  
Vol 104 (1) ◽  
pp. 003685042199887
Author(s):  
Guojie Zhai ◽  
Zhichao Huang ◽  
Huaping Du ◽  
Yuan Xu ◽  
Guodong Xiao ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Protection Device ◽  
Period Range ◽  
Chronic Total Occlusions ◽  
Endovascular Recanalization ◽  
Endovascular Revascularization ◽  
Balloon Protection

To investigate the feasibility, efficacy, and safety of endovascular recanalization for symptomatic chronic internal carotid artery occlusions (ICAO). Thirty patients with symptomatic chronic ICAO were treated using the endovascular recanalization method. Proximal balloon protection devices were used to prevent embolic migration by completely blocking the blood flow. The morphology of the internal carotid artery (ICA) at the occluded segment based on catheter angiography was analyzed. Recanalization of symptomatic chronic internal carotid artery occlusion (CICAO) was successful in 20 of the 30 patients (66.7%). The time required for successful revascularization ranged from 120 to 180 min (mean, 150 min). Of the 20 successful patients, 14 were at the cervical ICAs, and six were at the intracranial ICAs. No permanent complications occurred in our study. Ischemic symptoms related to chronic ICAO did not occur during the 18.3 month follow-up period (range, 12–24 months) in the 20 successful patients. Endovascular revascularization can improve hemodynamic compromise. The treated sites of all 20 successfully recanalized patients were patent on computed tomographic angiography or carotid duplex sonography, and no case with >50% restenosis was observed during the follow-up period. Three patients with failed recanalization had a stroke during the follow-up period. Endovascular revascularization of symptomatic CICAO using a proximal balloon protection device is technically feasible in selected patients, and the outcomes are favorable for patients who benefit from revascularization.

Results of Endovascular Treatment of Internal Carotid Artery Stenoses with a Newly Developed Balloon Protection Catheter

Neurosurgery ◽  
2003 ◽  
Vol 53 (3) ◽  
pp. 617-625 ◽  
Author(s):  
Tomoaki Terada ◽  
Mitsuharu Tsuura ◽  
Hiroyuki Matsumoto ◽  
Osamu Masuo ◽  
Hiroo Yamaga ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Transluminal Angioplasty ◽  
Resonance Imaging ◽  
Group I ◽  
Group Ii ◽  
Angioplasty And Stenting ◽  
Percutaneous Transluminal ◽  
Balloon Protection

Abstract OBJECTIVE A new balloon protection catheter to prevent distal emboli during internal carotid artery percutaneous transluminal angioplasty and stenting was developed, and its efficacy was evaluated in both an experimental model and clinical cases. METHODS The balloon protection catheter was navigated over a steerable 0.014-inch guidewire to negotiate tight stenoses and sharp bends, which would cause difficulties for the passage of a flow-directed balloon catheter. Percutaneous transluminal angioplasty and stenting were performed for 85 consecutive patients with 87 stenotic lesions of the cervical internal carotid artery, with two different methods using this protection system. Distal protection was provided only after dilation for the initial 38 lesions (Group I), but the latter 49 lesions were treated in both the pre- and postdilation periods (Group II). The effects of using the balloon protection catheter with the embolic debris clearance technique were evaluated with pre- and postoperative magnetic resonance imaging for each group. RESULTS The balloon protection catheter was introduced beyond the stenosis in all cases. In Group I, one symptomatic embolic stroke was caused by distal embolization resulting from atheromatous plaque, and high-intensity areas appeared on diffusion-weighted magnetic resonance imaging scans in 47% of cases. In contrast, in Group II, there were no strokes related to the procedure, although one patient with multiple risk factors died suddenly on the second day after stenting. Diffusion-weighted imaging scans demonstrated small, high-intensity areas in 19% of cases in Group II. The overall morbidity/mortality rate in our series was 2.3%. CONCLUSION Our new balloon protection catheter was reliably navigated across internal carotid artery stenoses and reduced distal embolism in clinical cases.

Management of Inoperable Cerebral Aneurysms by the Navigational Balloon Technique

Neurosurgery ◽  
1987 ◽  
Vol 21 (3) ◽  
pp. 296-302 ◽  
Author(s):  
Stuart M. Weil ◽  
Harry R. van Loveren ◽  
Thomas A. Tomsick ◽  
Barbara L. Quallen ◽  
John M. Tew
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Circulatory System ◽  
Cerebral Aneurysms ◽  
Aneurysm Neck ◽  
Carotid Ligation ◽  
Balloon Technique

Abstract Intravascular navigation with nondetachable balloons is a safe, effective method of treatment for inaccessible aneurysms of the internal carotid artery. The rate of ischemic complications is lower than that associated with carotid ligation, and the rate of subsequent hemorrhage is lower than that associated with either carotid ligation or direct clipping. Therefore, for many internal carotid artery aneurysms that originate at or proximal to the ophthalmic artery, the nondetachable balloon technique is an alternative treatment choice. During a 7-year period, 21 aneurysms of the internal carotid artery were treated by the nondetachable balloon technique. All 21 aneurysms were successfully excluded from the circulatory system by either proximal occlusion or trapping of the aneurysm neck. This series consisted of 8 carotid-ophthalmic artery aneurysms, 11 carotid-cavernous aneurysms (6 spontaneous, 5 traumatic), 1 petrous segment aneurysm, and 1 cervical segment aneurysm. At 3 years of follow-up, the following incidences were noted: transient ischemia, 4.7%; infarction, 9.6%; and hemorrhage, 0%. The complications were 1 case of transient hemiparesis and 2 late ischemic events. Fifty per cent of the patients underwent follow-up computed tomography, and thrombosis of the aneurysm was confirmed in all except one case, which was partially thrombosed.

Tortuosity of the Cervical Segment of the Internal Carotid Artery in AVM Patients

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 133-136
Author(s):  
J. Hamada ◽  
Y. Kai ◽  
M. Morioka ◽  
T. Kaku ◽  
K. Korematsu ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Distal Embolization ◽  
Cervical Segment ◽  
Group 2 ◽  
Group 1

The correlation between the degree of tortuosity of the cervical segment of the internal carotid artery (CICA) and the size of the nidus in AVM patients was investigated on angiograms. Fifteen AVM patients underwent embolization of vessels that were fed primarily by the internal carotid artery. The patients were divided into two groups according to the size of nidus: in group 1 (n = 5), the size of the nidus was rated as small (less than 6 cm), in group 2 (n = 10) as large (greater than 6 cm). The tortuosity was rated as mild, moderate, or severe. The tortuosity of the ipsilateral CICA in group 1 was severe while in group 2 it was either mild or moderate. The tortuosity of the CICA seems to be an important factor to be considered when distal embolization is contemplated in AVM patients.

scholarly journals Usefulness of contralateral carotid angiography in revascularization therapy of acute internal carotid artery occlusion

2018 ◽  
Vol 129 (2) ◽  
pp. 465-470
Author(s):  
Kiyoshi Tsuji ◽  
Nobuhiro Nakagawa ◽  
Norihito Fukawa ◽  
Masaharu Miyauchi ◽  
Kentaro Furukawa ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Carotid Angiography ◽  
Distal Embolization ◽  
Number Of Patients ◽  
Revascularization Therapy ◽  
Diagnostic Catheter

OBJECTIVEThe vascular lumen of an acutely occluded internal carotid artery (ICA) generally contains numerous thrombi. Therefore, carotid angiography on the affected side during revascularization therapy of acute ICA occlusion has a potential risk of causing distal embolization. In this study the authors propose the use of contralateral carotid angiography.METHODSSix patients with acute ICA occlusion underwent revascularization therapy using a stent retriever or Penumbra system. Revascularization therapy was performed with placement of a 9-Fr balloon-guiding catheter (BGC) in the affected ICA and a 4-Fr diagnostic catheter in the contralateral ICA. During the procedure, the 9-Fr BGC was kept inflated, and all control angiography was performed from the 4-Fr diagnostic catheter. After thrombectomy, contralateral carotid angiography combined with manual aspiration from the 9-Fr BGC was performed to assess the presence or absence of residual thrombi in the affected ICA. The 9-Fr BGC was deflated only after the complete absence of residual thrombi in the affected ICA was confirmed.RESULTSThe time required for introducing the 4-Fr diagnostic catheter into the contralateral ICA was within a few minutes in all patients. Residual thrombi in the affected ICA were found in 3 of 6 patients. The residual thrombi in these 3 patients were completely removed; thus, distal embolization was prevented.CONCLUSIONSContralateral carotid angiography is useful for avoiding distal embolization during revascularization therapy of acute ICA occlusion. Further studies involving a larger number of patients are warranted to verify the clinical efficacy of this contralateral carotid angiography.

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