Micro-Balloon

Catheter

for Superselective

Therapeutic

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H. PEVSNER’

Basic

A miniature (0.5 mm) flow-directed balloon catheter with two different silastic balloon tips has been developed. One tip is used for perfusion; the other can be inflated and released to produce vascular occlusion. Examples of the developmental work in dogs and clinical use in patients are presented. In 1930

Brooks

[1]

reported

embolizing

then

presented

of the small

several

investigators

same

approach,

catheters

with

[2-61 using

have either

detachable

major intracranial fistulae. Particulate matter is notoriously a catheter

would

seem

a more

The

particulate

0.5-1

distal

balloons

nonselective. selective

and

criteria

.0

mm

Requirements for

such

a catheter

should be totally into vessels with

without

producing

are

peutic 3.

variations

vivo

or

agents The for

at least

of fistulae

Therefore,

4. Detachment possible without systems.

predictable

The

(fig.

arterial

spasm

balloons

2 months

or aneurysms

catheter

to (fig.

should insure

Am

J Roentgeno/

128.225-230.

February

2,

be

inflated

225

British

in

occlusion

balloon should be or coaxial catheter

fashioned

so

that

absc’

Columbia,

June

1975.

‘a

and anterior spinal catheter (arrow) C. of arterial

spasm

1976.

of the American Society of Neuroradiology. Vancouver. Atlanta. Georgia. October 1975 College of Virginia. Richmond, Virginia 23298

1977

1).

3).

of a distal inflatable the use of polymers must

remain permanent

Fig. 1 . -A. Normal canine vertebral angiogram performed with no 5 French polyethylene catheter showing C2 branch (arrow) artery (double arrows). B, Vertebral angiogram showing occlusion of proximal orifice of left C2 arterial branch by inflated balloon Vertebral angiogram after 10 mm occlusion of C2 branch, showing deflated balloon catheter within orifice (arrow) No evidence anterior spinal artery (double arrows) or C2 branch November

(fig.

2).

detachable

to occlude

5.

Received July 9, 1976, accepted after revision Award paper presented at the annual meeting meeting of the American Roentgen Ray Society. Department of Radiology. Box 728. Medical

requisite.

flow directed and small an inside diameter of

2. It should be constructed for use in superselective angiography with water soluble contrast media, or for the injection of low viscosity polymers or chemothera-

with a silver artery. Since matter

following

1 . The catheter enough to pass

a posttraumatic

marked carotid

and

Occlusion

PAUL

carotid-cavernous fistula with muscle clip injected directly into the internal

Angiography

and

at the

annual

in

PEVSNER

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226

‘:

,-“,-

‘

‘‘a Fig. 2.-A, Perfusion balloon tip (double arrows) media (triple arrows).

control

with tion

of the

balloon and

detachable

catheter catheter

in proximal internal (arrow). C. Subtraction

balloon

is constantly

respect to inflation, deflation, of premature detachment (fig.

6. It should be possible system that could provide

of its position

(fig.

to use instant

position, 4).

the catheter angiographic

carotid film

artery of dog (arrows) B. Subtraction showing balloon catheter (arrow) and dilated

maintained

and

preven-

The

of both in a delivery verification

5). of Catheter

I have developed a polyethylene available commercially, which fulfills ments. It was constructed with two balloon tips-one for superselective fusion, and one for detachment and aneurysms, fistulae, or major feeders

catheter, soon to be the above requiredifferent silastic distal angiography or pervascular occlusion of of angiomata (fig. 6).

shown

in figure

outside catheters

film

balloon

diameter is 0.6

6 are of

mm,

showing

dilated

tip with

the

and

slightly distal

the

contrast-filled

distal-escaping

contrast

inflated. balloon

outside

The portion

diameter

of

the catheter tubing used for both balloon tips is 0.4 mm. The dark catheter in figure 6 has a perfusion tip, and the light one a detachable balloon tip. Both balloon tips are made

Description

balloons

uninflated

detail

in multiple

lengths

and

inflatable

specific purposes. The proximal tips are tightly stretched onto polyethylene

Perfusion

sizes

as needed

portions of both the distal portion

for

balloon of the

catheter.

Balloon

Tip

The perfusion balloon tip distal opening will only allow

is constructed so that the contrast media, elastomer,

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TECHNIQUE

(A) and

Fig. 3. -Anterposterior before examination and

inflated

or other perfusate of inflation of the the

inflated

balloon

can

to escape balloon.

balloon

a parachute

will,

effect

for

inflated

preventing

reflux

complication

virtue

during

of

its

direction; the

the

vessel

perfusate.

Reflux

embolization

using

(2)

achieve

once

Balloon

the

desired

position.

radiopaque firm

contact

pressure friction tip

within

onto

media

with

holding

reached, around

Then

contrast

Technique

catheter

being

perfused,

A

be

a serious

1 .1

particulate

matter

the

the

the

balloon

intimal

lining

it

exceeds

that

the

proximal

portion

polyethylene

is

of the of

the of

catheter.

inflated

until

the

its wall

vessel distal this

elastomer catheter,

seal

that requires

prevents

the

an

internal

balloon pressure

from

deflating. of

1 .75

The kg/cm2

French ID)

of dog

placed

3 months

provides a wide or premature

end water

through

this

the

injected

through

of

point

of

balloon

the

can is

leak with

balloon tion French

a

(fig.

The

back

bleeding

(fig.

7) is used

catheter

Rutherford,

and

the

is

then

catheter media

the

5 French

catheter.

no.

propelled side

arm wing allow

significant from

N.J.) A balloon contrast

to

on the

carotid flushing

(fig. 7). soluble

proximal

sufficiently without

or common A proximal

heparanized

Luer-Lok

mm OD, the artery

catheterize

is physically

7).

tightened

into

constant the

catheter or

adapter

catheter

hub

be

hub

( 1 .7

catheter

femoral, technique. Co.,

pushed

Use

selectively

(Becton-Dickinson

and

before

to

attached to its proximal filled with radiopaque

grapher,

balloon

polyethylene

is used

The

balloon

will and

5

mm

is in

slight tugging the balloon will be released. The stretched walls of the proximal portion of the balloon, no longer held apart by the catheter, come together creating a firm tip

no.

with

coefficient

When

the contrast material or the walls of the polyethylene

and

artery

for

of choice via the axillary, artery, using the Seldinger

distal inflated balloon catheter is placed in

or elastomer

carotid

release from the catheter. This of safety to prevent accidental

hub

for release of the distal balloon tip

in external

release.

Tip

The mechanism is as follows. The

(arrow)

227

the

or elastomer. Detachable

it will margin

balloon can

ANGIOGRAPHY

inflated detached balloon catheter angiographic contrast media.

inflation,

and

perfusion,

occlude of

showing iodinated

after a predetermined degree This has two advantages: (1)

by

for

to

lateral (B) views water soluble

flow

is in position

be

with

FOR SUPERSELECTIVE

the

artery.

the

angio-

flush

solution

in the

midportion

screw

on

is

the

propulsion

leakage

proximal

balloon

by

hub

of

of flush A

ends

is

the solu-

Touhy-Borst of the

no.

5

catheter.

Under fluoroscopic control, the tip of the contrast-filled balloon catheter is passed beyond the distal end of the no. At

5 French this

point,

catheter, both

blood

whereupon flow

the and

direct

balloon

is inflated.

manipulation

by

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228

H

PEVSNER

I

r

4,

‘-‘i .-

TECHNIQUE

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-.-.5--

FOR

SUPERSELECTIVE

229

ANGIOGRAPHY

-

++ I

(1

-

+

4,-

I

A’ t I

cm

.

Fig perfusion

the

6

-

Slightly balloon

propel

balloon will tend

orifice

‘_,#{149}l_

-a

‘I

the

segment, Ml than

large

since in the

balloon can

of

hub

position

the

via the

will Fig 5.-A, principally by

Lateral angiogram pericallosal artery

artery with distal verifying position artery

of B.

left posterior parietal angioma Balloon catheter (arrows) in

uninflated of balloon

balloon tip tip (triple

fed

allow

with

a high

for

either degree

to

no.

choroidal into

and

the

Ml

in the artery allow

the

Angiography

arm

5 French

to check catheter

balloon tip and allow

greater carotid

segment. side

deflaof fluid arterial

the opthalmic

anterior pass

gradient

Al

Luer-Lok

the

selective

may

the

flow the

distally.

the entry

is generally Contralateral

this

of the

proximal

catheter

around

the exact intravascular (fig. 5C). Once the desired angiography.

perfusion,

or

be achieved.

In summary, a flow-directed detachable and perfusion

.c.

of

of

and

and

forces into any

it (e.g.,

tends

into

through

release

origin

change to pass

is obtained,

balloon

catheter

inflation will prevent

catheter

arrows)

inflation

to accept

siphon), orifice

the balloon catheter position of the balloon

A;

pericallosal Angiogram pericallosal

can

be performed

flushing

balloon

blood flow Al segment.

catheter

(double

successive

enough

balloon

compression .4

,

the

by

in the carotid than such an

artery,

balloon

tip. Since the natural to thrust the balloon

easy distal passage. Above the level

i.

the

branch

.‘T

detachable (arrow)

is controlled

tion of dynamics

.‘1:-:.

inflated catheters

angiographer

Selectivity

artery larger

cm

tips

vascular of

safety.

balloon catheter with has been developed

occlusion

or

perfusion,

control,

and

reliability.

both that both

distal

(triple arrows) C. arrows) in distal

ACKNOWLEDGMENTS I thank assistance the

manuscript.

David and

C.

Dillard

Judy

Lee

and for

Tom secretarial

W.

Fouts

for

technical

work

in

preparing

230

PEVSNER

,j,il,ii,liitti,

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It

.

llllIIlIIlIIlIUIlIIllII....,

I.

4 Fig.

7.-Entire

system with able balloon

Borst adapters proximal flushing

I

and no. catheter.

REFERENCES

2. Luessenhop

AJ:

Artificial

of traumatic 26, 1930 embolization

arterio-venous

fistula.

inoperable

arterio-

malformations, in Cerebral Angiomas, edited by Pia HW, Cleave JRW, Grote E, Zierski J, Berlin. Springer. 1975. pp 198-201 3. Hilal 5, Michelsen WJ, Driller J: Pod catheter: a means for small vessel exploration. J AppI Phys 40:1046. 1969 Kricheff

1K, Madayag

M.

Braunstein

embolization malformation. 5. Serbinenko

of

venous

4.

catheter

inflated detach(arrow), Touhy(double arrows). hub (triple arrows),

5 French

polyethylene

tt

Itt 1. Brooks B: The treatment South MedJ 23:100-1

balloon

slightly catheter

P: Transfemoral

catheter

of cerebral

and posterior 103:107-111,

Radiology FA:

Balloon

catheterization

fossa 1972 and

arteriovenous occlusion

of

41:1 25-145. 1 974 6. Debrun G. Lacour P. Caron JP. Keravel Y. Comoy J. Loisance 0: The treatment of arterio-venous fistulas and aneurysms with an inflatable released balloon: experimental work, application in man, in Advances in CerebralAngiography, INSERM Symposium. Marseilles. May 1975, edited by Salamon G. major

Berlin.

cerebral

Springer.

vessels.

1975.

J Neurosurg

pp

198-205