Initial experience with the Scepter Mini catheter for the embolization of vascular malformations in the pediatric population

2021 ◽  
pp. 197140092110490
Author(s):  
Stavros Matsoukas ◽  
Devin Bageac ◽  
Kurt Yaeger ◽  
Alejandro Berenstein ◽  
Johanna T Fifi ◽  
...  
Keyword(s):  
Flow Control ◽  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Pediatric Population ◽  
Balloon Catheter ◽  
Retrospective Chart Review ◽  
Endovascular Embolization ◽  
Uneventful Recovery ◽  
Initial Experience ◽  
Low Profile

Background Achieving distal access and flow control are of significant importance for the treatment of intracerebral arteriovenous shunting lesions. The Scepter Mini catheter is a low-profile, dual-lumen balloon catheter, designed to provide navigability in small-caliber, tortuous intracranial vessels. Objective To describe the initial experience of the Scepter Mini catheter in the treatment of pediatric arteriovenous malformations and fistulas. Methods A single-institution, retrospective chart review identified all consecutive uses of the Scepter Mini catheter for endovascular embolization of vascular malformations in the pediatric population. Results Three different arterial pedicles were embolized with the Scepter Mini catheter in two different patients. One patient was diagnosed with a vein of Galen malformation that had undergone multiple treatments and the other with a torcular dural arteriovenous fistula. All cases encompassed quite challenging tortuosity of small-caliber feeders which prevented the use of another microcatheter. The Scepter Mini catheter navigated into feeding arteries of diameters 0.65, 1.9, and 1.25 mm, and its balloon was inflated to achieve excellent blood flow control. Total obliteration (100%) of the shunting lesion was achieved in both cases. No reflux, pedicle rupture or other untoward effects were observed. Both patients had an uneventful recovery. Conclusion The Scepter Mini catheter afforded fast and safe distal access, flow control, and treatment of arteriovenous malformations in this initial pediatric cohort. The catheter’s low profile and easy navigability should support its use in tortuous and small arterial feeders, especially in the pediatric population.

Abstract 1122‐000090: Initial Experience with the Scepter Mini; Embolization of Vascular Malformations in the Pediatric Population

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Stavros Matsoukas ◽  
Devin Bageac ◽  
Kurt Yaeger ◽  
Alejandro Berenstein ◽  
Johanna Fifi ◽  
...  
Keyword(s):  
Flow Control ◽  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Pediatric Population ◽  
Balloon Catheter ◽  
Retrospective Chart Review ◽  
Endovascular Embolization ◽  
Uneventful Recovery ◽  
Initial Experience ◽  
Low Profile

Introduction : Achieving distal access and flow control provides a significant advantage for the treatment of intracerebral arteriovenous shunting lesions. The Scepter Mini Catheter (SMC) is a low‐profile, dual‐lumen balloon catheter, designed to provide navigability in small‐caliber, tortuous intracranial vessels. We sought to describe the initial experience of the SMC in the treatment of pediatric arteriovenous malformations and fistulas. Methods : A single‐institution, retrospective chart review identified all consecutive uses of the SMC for endovascular embolization of vascular malformations in the pediatric population. Results : Three different arterial pedicles were embolized with the SMC in two different patients. One patient was diagnosed with a vein of Galen malformation that had undergone multiple treatments and the other with a torcular dural arteriovenous fistula. All cases encompassed quite challenging tortuosity of small‐caliber feeders which precluded the use of another balloon microcatheter. The SMC navigated into feeding arteries of diameters 0.65, 1.9 and 1.25 mm, and its balloon was inflated to achieve excellent blood flow control. Total obliteration (100%) of the shunting lesion was achieved in both cases. No reflux, pedicle rupture or other untoward effects were observed. Both patients had an uneventful recovery. Conclusions : The SMC afforded fast and safe distal access, flow control and treatment of arteriovenous malformations in this initial pediatric cohort. The catheter’s low profile and easy navigability should support its use in tortuous and small arterial feeders, especially in the pediatric population.

Abstract TMP120: Endovascular Balloon-Assisted Embolization of Intracranial Arteriovenous Malformations Using Dual Lumen Co-Axial Balloon Microcatheters and Onyx: Initial Experience.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Bharathi D Jagadeesan ◽  
Mikayel Grigoryan ◽  
Ameer E Hassan ◽  
Andrew W Grande ◽  
Ramachandra P Tummala
Keyword(s):  
Arteriovenous Malformations ◽  
Balloon Catheter ◽  
Arterial Embolization ◽  
Initial Experience ◽  
Intracranial Arteriovenous Malformations ◽  
Balloon Inflation ◽  
Ethylene Vinyl Alcohol ◽  
Catheter Navigation ◽  
Brain Avms ◽  
Vessel Rupture

Background: Ethylene Vinyl alcohol co-polymer (Onyx) is widely used for embolization of intracranial arteriovenous malformations. Traditional catheter based techniques for Onyx infiltration may be associated with reflux of Onyx resulting in cathteter retention, vessel rupture or reflux into en-passage arteries. Balloon assisted Onyx embolization may eliminate some of these problems encountered with traditional catheter based techniques. Herein, we report our initial experience in performing balloon assisted AVM embolization for brain AVMs and dural AVFs using the new Scepter-C and Scepter-XC co- axial dual lumen balloon microcatheters. Methods: Balloon-assisted trans-arterial embolization was carried out in a series of six patients (5 with brain AVMs, one with a dural AVF ) using Onyx delivered through the lumen of Scepter-C or Scepter XC co-axial balloon microcatheters. Following initial balloon-catheter navigation into a feeding artery as close to the nidus of the malformation as possible, and subsequent balloon inflation, embolization was performed using Onyx 18 or Onyx 34 or both. The balloon was delated and removed once adequate embolization had been achieved. Results: A total of ten embolization sessions were performed via fifteen arterial feeders in these five patients. In one out of fifteen vessels (7%), there was a quickly controlled arterial perforation from balloon inflation, in all others embolization goals for each session were successfully achieved with no adverse events. Conclusion: We found that the balloon microcatheters showed excellent navigability and there were no problems with retrieval or repeated inflation and deflation of the balloons. Using this technique, we were able to avoid the need for formation of a proximal Onyx plug and its associated risks. Additionally, fluoroscopy and procedural times seemed lower with this technique compared to conventional embolization methods.

Progressive Gait Dysfunction

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Endovascular Embolization ◽  
Arteriovenous Fistulas ◽  
Progressive Myelopathy ◽  
Spinal Vascular Malformations ◽  
Gait Dysfunction ◽  
Dural Arteriovenous Fistulas ◽  
Neurological Change ◽  
Spinal Arteriovenous Malformations

Spinal vascular malformations are rare, with dural arteriovenous fistulas (AVFs) accounting for the majority of the pathology. Unlike spinal arteriovenous malformations, which cause abrupt neurological change as a result of hemorrhage, spinal dural AVFs tend to result in a progressive myelopathy through venous congestion and cord edema. If diagnosed and treated early with endovascular embolization or microsurgery, some deficits may be reversible.

scholarly journals Spontaneous intracranial hemorrhage in children – ruptured lobar arteriovenous malformations: report of two cases

2015 ◽  
Vol 22 (1) ◽  
pp. 86-93
Author(s):  
A. Tascu ◽  
C. Pascal ◽  
S.M. Florea ◽  
St.M. Iencean
Keyword(s):  
Intracranial Hemorrhage ◽  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Pediatric Population ◽  
Bleeding Risk ◽  
Neurological Status ◽  
Recurrent Bleeding ◽  
Surgical Interventions ◽  
Spontaneous Intracranial Hemorrhage ◽  
Angiographic Examination

Abstract Brain arteriovenous malformations (AVMs) are lesions thought to be primarily congenital in origin, consisting of fistulous connections of abnormal arteries and veins, without normal intervening capillary beds and no cerebral parenchyma between vessels. In the pediatric population, AVMs represent the most common cause of spontaneous intracranial hemorrhage (ICH), with a high recurrent bleeding risk. The aim of this paper is to report 2 cases of ruptured lobar AVMs in children, presenting with spontaneous ICH. Due to the patients’ neurological status, the only imaging examination performed preoperatively was a CT scan, showing intraparenchymal hemorrhage. Thus, there was no MRI/angiographic examination to prove the existence of a brain AVM prior to the surgical interventions. Also, the cerebral angiography performed after the surgery showed, in both patients, no signs of residual vascular malformations. Therefore, the diagnosis of AVM was certified by macroscopic and microscopic pathological findings, with no brain imaging suggestive of a vascular malformation.

Endovascular Balloon-Assisted Embolization of Intracranial and Cervical Arteriovenous Malformations Using Dual-Lumen Coaxial Balloon Microcatheters and Onyx

2013 ◽  
Vol 73 (2) ◽  
pp. ons238-ons243 ◽  
Author(s):  
Bharathi D. Jagadeesan ◽  
Mikayel Grigoryan ◽  
Ameer E. Hassan ◽  
Andrew W. Grande ◽  
Ramachandra P. Tummala
Keyword(s):  
Arteriovenous Malformations ◽  
Dural Arteriovenous Fistula ◽  
Transarterial Embolization ◽  
Balloon Catheter ◽  
Initial Experience ◽  
Feeding Artery ◽  
Ethylene Vinyl Alcohol ◽  
Catheter Navigation ◽  
Brain Avms ◽  
The Brain

Abstract BACKGROUND: Ethylene vinyl alcohol copolymer (Onyx) is widely used for the embolization of arteriovenous malformations (AVMs) of the brain, head, and neck. Balloon-assisted Onyx embolization may provide additional unique advantages in the treatment of AVMs in comparison with traditional catheter-based techniques. OBJECTIVE: To report our initial experience in performing balloon-assisted AVM embolization for brain and neck AVMs with the use of the new Scepter-C and Scepter-XC coaxial dual-lumen balloon microcatheters. METHODS: Balloon-assisted transarterial embolization was performed in a series of 7 patients with AVMs (4 with brain AVMs, 1 with a dural arteriovenous fistula, and 2 with neck AVMs) by using Onyx delivered through the lumen of Scepter-C or Scepter XC coaxial balloon microcatheters. Following the initial balloon-catheter navigation into a feeding artery and the subsequent inflation of the balloon, the embolization was performed by using Onyx 18, Onyx 34, or both. RESULTS: A total of 12 embolization sessions were performed via 17 arterial feeders in these 7 patients. In 1 patient, there was an arterial perforation from the inflation of the balloon; in all others, the embolization goals were successfully achieved with no adverse events. CONCLUSION: The balloon microcatheters showed excellent navigability, and there were no problems with retrieval or with the repeated inflation and deflation of the balloons. A proximal Onyx plug, which is crucial in many AVM embolizations, was not necessary with this technique. Additionally, fluoroscopy and procedural times seemed lower with this technique compared with conventional embolization methods.

scholarly journals Glue, Onyx, Squid or PHIL? Liquid Embolic Agents for the Embolization of Cerebral Arteriovenous Malformations and Dural Arteriovenous Fistulas

2021 ◽  
Author(s):  
Dominik F. Vollherbst ◽  
René Chapot ◽  
Martin Bendszus ◽  
Markus A. Möhlenbruch
Keyword(s):  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Endovascular Embolization ◽  
Embolic Agent ◽  
Cerebral Arteriovenous Malformations ◽  
Arteriovenous Fistulas ◽  
Advantages And Disadvantages ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Dural Arteriovenous Fistulas

Abstract Background Endovascular embolization is an effective treatment option for cerebral arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs). A variety of liquid embolic agents have been and are currently used for embolization of AVMs and DAVFs. Knowledge of the special properties of the agent which is used is crucial for an effective and safe embolization procedure. Material and Methods This article describes the properties and indications of the liquid embolic agents which are currently available: cyanoacrylates (also called glues), and the copolymers Onyx, Squid and PHIL, as well as their respective subtypes. Results Cyanoacrylates were the predominantly used agents in the 1980s and 1990s. They are currently still used in specific situations, for example for the occlusion of macro-shunts, for the pressure cooker technique or in cases in which microcatheters are used that are not compatible with dimethyl-sulfoxide. The first broadly used copolymer-based embolic agent Onyx benefits from a large amount of available experience and data, which demonstrated its safety and efficacy in the treatment of cerebral vascular malformations, while its drawbacks include temporary loss of visibility during longer injections and artifacts in cross-sectional imaging. The more recently introduced agents Squid and PHIL aim to overcome these shortcomings and to improve the success rate of endovascular embolization. Novelties of these newer agents with potential advantages include extra-low viscosity versions, more stable visibility, and a lower degree of imaging artifacts. Conclusion All the available liquid embolic agents feature specific potential advantages and disadvantages over each other. The choice of the most appropriate embolic agent must be made based on the specific material characteristics of the agent, related to the specific anatomical characteristics of the target pathology.

scholarly journals Initial experience with precipitating hydrophobic injectable liquid in cerebral arteriovenous malformations

2018 ◽  
Vol 25 (1) ◽  
pp. 58-65 ◽  
Author(s):  
Stanimir S Sirakov ◽  
Alexander Sirakov ◽  
Krasimir Minkin ◽  
Hristo Hristov ◽  
Kristian Ninov ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Endovascular Embolization ◽  
Embolic Agent ◽  
Initial Experience ◽  
Cerebral Arteriovenous Malformations ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Reported Study ◽  
Liquid Embolic Agent ◽  
Staged Treatment

Background Precipitating hydrophobic injectable liquid is a newly introduced liquid embolic agent for endovascular embolization with some technical advantages over other liquid embolic agents. We present our initial experience with precipitating hydrophobic injectable liquid in the endovascular treatment of cerebral arteriovenous malformations. Methods From October 2015 to January 2018, 27 patients harboring cerebral arteriovenous malformations underwent endovascular embolization with precipitating hydrophobic injectable liquid 25. Clinical features, angiographic results, procedural details, complications, and follow-up details were retrospectively analyzed. Results Twenty-seven patients with cerebral arteriovenous malformations were included. Total obliteration in one endovascular session was confirmed for 14/27 (52%) patients. Partial embolization was attained in 13 patients (48%) in whom staged treatment with following radiosurgery or surgery was planned. No mortality was recorded in this series. Complications during or after the embolization occurred in six of 27 (22.2%) patients. Conclusion In our initial experience, precipitating hydrophobic injectable liquid has acceptable clinical outcome comparable to other liquid embolic agents. Although this is the largest reported study in arteriovenous malformation treatment with precipitating hydrophobic injectable liquid, further studies are needed to validate its safety and efficacy.

Treatment of pediatric intracranial vascular malformations using Onyx-18

2008 ◽  
Vol 2 (3) ◽  
pp. 171-176 ◽  
Author(s):  
Brian T. Jankowitz ◽  
Nirav Vora ◽  
Tudor Jovin ◽  
Michael Horowitz
Keyword(s):  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Pediatric Population ◽  
Embolic Agent ◽  
Vein Of Galen ◽  
High Output Heart Failure ◽  
Long Term Follow Up ◽  
Liquid Embolic Agent ◽  
Repeat Angiography

Object Onyx-18 is a relatively new liquid embolic agent. The initial success with this polymer will result in increased utilization in children, but its use and safety in the pediatric population have not been firmly established. Methods Between December 2005 and January 2008, the cerebral vascular malformations in 6 children were embolized using Onyx-18. The ages of the patients ranged from 1 day to 12 years. Pathological types of the vascular malformations included 4 arteriovenous malformations and 2 vein of Galen malformations. Clinical presentations included intracranial hemorrhage in 2 patients, papilledema in 1 patient, and high-output heart failure in 3 patients. Results In 6 pediatric patients, 21 embolization procedures were performed utilizing a combination of Onyx-18, platinum coils, and Embosphere microspheres. The average estimated size reduction for the arteriovenous malformations was 60%. Total obliteration of a malformation was achieved in 1 patient. Two patients received adjuvant radiosurgery. Of the 2 vein of Galen malformations, one was completely embolized and the other had an ~ 50% reduction in flow. No open surgical intervention was used. Clinical follow-up ranged from 7 to 12 months. Angiographic follow-up data were obtained at 1, 6, and 7 months in 3 patients, whereas 1 patient awaits repeat angiography. Complications included a transient monoparesis with complete resolution in 1 patient. Two patients died within 24 hours of an embolization procedure due to intracranial hemorrhages. Conclusions Onyx-18 is a feasible embolization agent for use in intracranial vascular malformations in the pediatric population, but long-term follow-up data will be necessary to assess the continued efficacy and safety of this agent.

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