Skip to main content
SpringerLink
Log in

One-step solution for angioplasty, low-profile stent delivery, and intrastent dilation using a dual-lumen angioplasty balloon microcatheter: technical advances, limitations, outcomes, and literature review

  • Research
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Dual-lumen angioplasty balloon microcatheters make it possible to perform percutaneous transluminal angioplasty (PTA), low-profile stent delivery, and intrastent dilation without the microcatheter exchange technique. This technique has shown many advantages in recent years. We reviewed the techniques and applications in different intracranial vascular diseases and summarized the outcomes and indications. Gateway dual-lumen angioplasty balloon was used for PTA and kept in situ. Stent was delivered and deployed via Gateway microcatheter. Intrastent balloon dilation was performed after stent deployment. We retrospectively reviewed the clinical and imaging data, surgical procedures, technique application, and follow-up outcomes of six patients treated from 2020 to 2023. Neurological function was assessed by the modified Rankin scale (mRS). A literature review was performed using PubMed. All seven patients (4 males, 3 females; mean age, 62.6 ± 6.9 years) underwent percutaneous transluminal angioplasty and stent deployment using a balloon microcatheter. There was one middle cerebral artery (MCA) aneurysm with parent artery stenosis, two MCA dissections, and four intracranial atherosclerotic stenoses (ICASs). The mRS score was 0 in five patients and 1 in two patients. Cerebral dissection with stenosis is the best indication, and its application in stent-assisted aneurysm coiling is inappropriate. This technique is controversial in ICAS treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

Data availability

The datasets used or analyzed during the current study are available from the corresponding authors on reasonable request.

Code availability

Not applicable.

References

  1. Buonomo O, Mormina E, Caragliano AA, Tessitore A, Pitrone A, Velo M, Cavallaro M, Visalli C, Granata F, Vadalà C, Vinci SL (2021) Safety and effect of Neuroform Atlas stent in the treatment of symptomatic intracranial stenosis: a single-center experience. Heliyon 7:e08040. https://doi.org/10.1016/j.heliyon.2021.e08040

    Article  PubMed  PubMed Central  Google Scholar 

  2. Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, Janis LS, Lutsep HL, Barnwell SL, Waters MF, Hoh BL, Hourihane JM, Levy EI, Alexandrov AV, Harrigan MR, Chiu D, Klucznik RP, Clark JM, McDougall CG, Johnson MD, Pride GL, Torbey MT, Zaidat OO, Rumboldt Z, Cloft HJ (2011) Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 365. https://doi.org/10.1056/NEJMoa1105335

  3. Cuellar H, Barry J, Hanif R (2020) A novel technique for stenting in cases of refractory intracranial stenosis. Interv Neuroradiol 26:337–340. https://doi.org/10.1177/1591019919900832

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cui R, Yan L, Kang K, Yang M, Yu Y, Mo D, Gao F, Wang Y, Lou X, Miao Z, Ma N (2021) Long-Term outcome of enterprise stenting for symptomatic ICAS in a high-volume stroke center. Front Neurol 12:672662. https://doi.org/10.3389/fneur.2021.672662

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gao P, Wang T, Wang D, Liebeskind DS, Shi H, Li T, Zhao Z, Cai Y, Wu W, He W, Yu J, Zheng B, Wang H, Wu Y, Dmytriw AA, Krings T, Derdeyn CP, Jiao L (2022) Effect of stenting plus medical therapy vs medical therapy alone on risk of stroke and death in patients with symptomatic intracranial stenosis: the CASSISS Randomized clinical trial. JAMA 328:534–542. https://doi.org/10.1001/jama.2022.12000

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Guenego A, Zerlauth J-B, Puccinelli F, Hajdu S, Rotzinger DC, Zibold F, Piechowiak EI, Mordasini P, Gralla J, Dobrocky T, Daniel RT, Chapot R, Mosimann PJ (2018) Balloon-assisted coil embolization and large stent delivery for cerebral aneurysms with a new generation of dual lumen balloons (Copernic 2L). J Neurointerv Surg 10:395–400. https://doi.org/10.1136/neurintsurg-2017-013218

    Article  PubMed  Google Scholar 

  7. Kim J-H, Jung Y-J, Chang C-H (2021) Feasibility and safety of the strategy of first stenting without retrieval using Solitaire FR as a treatment for emergent large-vessel occlusion due to underlying intracranial atherosclerosis. J Neurosurg 135:1091–1099. https://doi.org/10.3171/2020.8.JNS202504

    Article  PubMed  Google Scholar 

  8. Li T, Wang Y, Ma J, Levitt M, Mossa-Basha M, Shi C, Ran Y, Ren J, Han X, Zhu C (2021) Application of high-resolution flat detector computed tomography in stent implantation for intracranial atherosclerotic stenosis. Front Neurosci 15:655594. https://doi.org/10.3389/fnins.2021.655594

    Article  PubMed  PubMed Central  Google Scholar 

  9. Memon MZ, Ezzeldin M, Biswas A, Ahmad R, Nisar T, Singla A, Muhammad N, Shaltoni H, Kan P, Zaidat OO, Khandelwal P (2023) Novel technique of stent placement via Gateway balloon in intracranial atherosclerosis-associated large vessel occlusion. J Neuroimaging. https://doi.org/10.1111/jon.13139

    Article  PubMed  Google Scholar 

  10. Meyer L, Leischner H, Thomalla G, Krause LU, Lowens S, Rothaupt J, Hanning U, Buhk JH, Fiehler J, Chapot R, Stracke CP, Bester M (2020) Stenting with Acclino (flex) for symptomatic intracranial stenosis as secondary stroke prevention. J Neurointerv Surg 12:1127–1131. https://doi.org/10.1136/neurintsurg-2019-015744

    Article  PubMed  Google Scholar 

  11. Mosimann PJ, Yamac E, Wallocha M, Ayad A, Chapot R (2022) LVIS EVO stent-through-balloon after hydrocoil embolization of intracranial aneurysms: one-year results. Interv Neuroradiol:15910199221138151. https://doi.org/10.1177/15910199221138151

  12. Pagano P, Calvão Pires P, Paiusan L, Soize S, Manceau PF, Pierot L (2022) Deployment of low-profile flow-diverter through a double lumen balloon catheter (remo-diversion technique) to treat recurrent middle cerebral artery bifurcation aneurysm: a technical note. Interv Neuroradiol:15910199221091647. https://doi.org/10.1177/15910199221091647

  13. Spiotta AM, Miranpuri A, Chaudry MI, Turner RD 4th, Turk AS (2013) Combined balloon stent technique with the Scepter C balloon and low-profile visualized intraluminal stent for the treatment of intracranial aneurysms. J Neurointerv Surg 5 (Suppl 3):iii79–iii82. https://doi.org/10.1136/neurintsurg-2012-010553

  14. Stracke CP, Meyer L, Fiehler J, Leischner H, Bester M, Buhk JH, Thomalla G, Krause LU, Lowens S, Rothaupt J, Chapot R, Hanning U (2020) Intracranial bailout stenting with the Acclino (Flex) Stent/NeuroSpeed Balloon Catheter after failed thrombectomy in acute ischemic stroke: a multicenter experience. J Neurointerv Surg 12:43–47. https://doi.org/10.1136/neurintsurg-2019-014957

    Article  PubMed  Google Scholar 

  15. Takayanagi A, Cheng PK, Feng L (2021) A novel technique for stenting of intracranial stenosis using the Neuroform Atlas stent and Gateway balloon catheter. Interv Neuroradiol 27:770–773. https://doi.org/10.1177/15910199211007295

    Article  PubMed  PubMed Central  Google Scholar 

  16. Yi HJ, Sung JH, Lee DH (2021) Preliminary experience of Neuroform Atlas stenting as a rescue treatment after failure of mechanical thrombectomy caused by residual intracranial atherosclerotic stenosis. J Korean Neurosurg Soc 64:198–206. https://doi.org/10.3340/jkns.2020.0146

    Article  PubMed  PubMed Central  Google Scholar 

  17. Zaidat OO, Fitzsimmons B-F, Woodward BK, Wang Z, Killer-Oberpfalzer M, Wakhloo A, Gupta R, Kirshner H, Megerian JT, Lesko J, Pitzer P, Ramos J, Castonguay AC, Barnwell S, Smith WS, Gress DR (2015) Effect of a balloon-expandable intracranial stent vs medical therapy on risk of stroke in patients with symptomatic intracranial stenosis: the VISSIT randomized clinical trial. JAMA 313:1240–1248. https://doi.org/10.1001/jama.2015.1693

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors thank Yingtao Liu for imaging processing.

Funding

This study was supported by the Special Clinical Research Project in Health Industry of Shanghai Municipal Health Commission (no. 20224Y0072 to PL).

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China

    Peixi Liu, Hongfei Zhang, Yuan Shi, Zongze Li, Peiliang Li & Yanlong Tian

  2. National Center for Neurological Disorders, Shanghai, 200040, China

    Peixi Liu, Hongfei Zhang, Yuan Shi, Zongze Li, Peiliang Li & Yanlong Tian

  3. Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China

    Peixi Liu, Hongfei Zhang, Yuan Shi, Zongze Li, Peiliang Li & Yanlong Tian

  4. Neurosurgical Institute of Fudan University, Shanghai, 200040, China

    Peixi Liu, Hongfei Zhang, Yuan Shi, Zongze Li, Peiliang Li & Yanlong Tian

  5. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China

    Peixi Liu, Hongfei Zhang, Yuan Shi, Zongze Li, Peiliang Li & Yanlong Tian

  6. Department of Radiology, Huashan Hospital of Fudan University, Shanghai, 200040, China

    Yingtao Liu

Authors
  1. Peixi Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hongfei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuan Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zongze Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yingtao Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peiliang Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yanlong Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Peixi Liu: conception and design of study, provision of study material, collection and/or assembly of data, data analysis and interpretation, manuscript writing, and final approval of manuscript.

Hongfei Zhang and Yuan Shi: data analysis and interpretation, manuscript writing.

Zongze Li: database input and data interpretation.

Yingtao Liu and Kai Quan: imaging processing.

Yanlong Tian and Peiliang Li: provision of study and revision and final approval of manuscript.

Yanlong Tian: conception and design of study and revision and final approval of manuscript.

PL and HZ contributed to this work equally.

YT and PL are co-corresponding authors of this article.

Corresponding authors

Correspondence to Peiliang Li or Yanlong Tian.

Ethics declarations

Ethics approval

This study was approved by the ethics committees of Huashan Hospital, Fudan University.

Consent to participate

Written informed consent was obtained from individual or guardian participants.

Consent for publication

All patients with comprehensive medical data were consented to the publication of their medical images.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, P., Zhang, H., Shi, Y. et al. One-step solution for angioplasty, low-profile stent delivery, and intrastent dilation using a dual-lumen angioplasty balloon microcatheter: technical advances, limitations, outcomes, and literature review. Neurosurg Rev 46, 234 (2023). https://doi.org/10.1007/s10143-023-02143-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10143-023-02143-9

Keywords

Search

Navigation