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At least 19 recordsLinked to original sources
PubMed2006

Cerebral ischemia associated with PercuSurge balloon occlusion balloon during carotid stenting: Incidence and possible mechanisms.

BACKGROUND: Interruption of antegrade cerebral perfusion results in transient neurologic intolerance in some patients undergoing carotid angioplasty and stenting (CAS). This study sought to evaluate factors that contributed to the development of cerebral ischemia during PercuSurge balloon occlusion and techniques used to allow successful completion of the CAS procedure. METHODS: The PercuSurge occlusion balloon was used in 43 of 165 patients treated with CAS for high-grade stenosis (mean stenosis, 90%). All 43 patients were at increased risk for endarterectomy (7 restenosis, 3 irradiation, 3 contralateral occlusion, and 30 Goldman class II-III); 20% were symptomatic. Symptoms of cerebral hypoperfusion during temporary occlusion of the internal carotid artery occurred in 10 of 43 and included dysarthria (7/10), agitation (6/10), decreased level of consciousness (5/10), and focal hemispheric deficit (3/10). An incomplete circle of Willis or contralateral carotid artery occlusion, or both, was present in 8 of 10 patients. Symptoms resulting from PercuSurge balloon occlusion were managed by balloon deflation with or without evacuation of blood from the internal carotid artery using the Export catheter. All symptoms resolved completely without deficit after deflation of the occlusion balloon. RESULTS: The development of neurologic symptoms after initial PercuSurge balloon inflation and occluded internal carotid artery flow was associated with a decrease in the mean Glasgow Coma Scale (GCS) from 15 to 10 (range, 9 to 14); the GCS returned to normal after occlusion balloon deflation and remained normal during subsequent reinflation. The mean time to spontaneous recovery of full neurologic function was 8 minutes (range, 4 to 15 minutes). No thrombotic or embolic events were present on cerebral angiography or computed tomography scan. Balloon reinflation was performed after a mean reperfusion interval of 10 minutes after full neurologic recovery (range, 4 to 20 minutes). The mean subsequent procedure duration was 11.9 minutes (range, 6 to 21 minutes). No recurrence of neurologic symptoms occurred when the occlusion balloon was reinflated. All 10 patients underwent successful CAS without occlusion, dissection, cerebrovascular accident, or death. CONCLUSION: Several factors may contribute to the development of neurologic intolerance during CAS with balloon occlusion. Elucidation of the protective cellular mechanisms that invoke ischemic tolerance after the initial transient ischemic event may enable CAS with embolic protection in patients who cannot tolerate initial interruption of antegrade cerebral perfusion.

Aged↗
PubMedDate not supplied

Percutaneous treatment of extrahepatic bile duct stones assisted by balloon sphincteroplasty and occlusion balloon.

OBJECTIVE: To describe the technical feasibility and usefulness of extrahepatic biliary stone removal by balloon sphincteroplasty and occlusion balloon pushing. MATERIALS AND METHODS: Fifteen patients with extrahepatic bile duct stones were included in this study. Endoscopic stone removal was not successful in 13 patients, and two patients refused the procedure due to endoscopy phobia. At first, all patients underwent percutaneous transhepatic biliary drainage (PTBD). A few days later, through the PTBD route, balloon assisted dilatation for common bile duct (CBD) sphincter was performed, and then the stones were pushed into the duodenum using an 11.5 mm occlusion balloon. Success rate, reason for failure, and complications associated with the procedure were evaluated. RESULTS: Eight patients had one stone, five patients had two stones, and two patients had more than five stones. The procedure was successful in 13 patients (13/15). In 12 of the patients, all stones were removed in the first trial. In one patient, residual stones were discovered on follow-up cholangiography, and were subsequently removed in the second trial. Technical failure occurred in two patients. Both of these patients had severely dilated CBD and multiple stones with various sizes. Ten patients complained of pain in the right upper quadrant and epigastrium of the abdomen immediately following the procedure, but there were no significant procedure-related complications such as bleeding or pancreatitis. CONCLUSION: Percutaneous extrahepatic biliary stone removal by balloon sphincteroplasty and subsequent stone pushing with occlusion balloon is an effective, safe, and technically feasible procedure which can be used as an alternative method in patients when endoscopic extrahepatic biliary stone removal was not successful.

Aged↗
PubMed1999

An emergency balloon occlusion system for a rotary blood pump left ventricular assist system.

A fatal outcome is expected in a left ventricular assist system (LVAS) utilizing a rotary blood pump if there is no mechanism to prevent the backflow from the aorta to the heart in the case of acute pump failure. To solve this problem, a passive mechanical clamping system at the outflow graft of a rotary blood pump was developed together with Fuji Systems, Inc., Yokohama, Japan. The system consisted of an emergency clamp port and an occlusion balloon. The balloon was fixed around the outlet graft of the LVAS. In an in vitro study, a fail-safe clamping operation with 2 ml saline injection under 7 L/min flow against 140 mm Hg pressure reduced the flow to 0.5 L/min while the pressure in the system increased to 190 mm Hg. The systems were also applied to 2 in vivo LVAD studies. When the pumps were stopped, there were approximately 3.0 L/min regurgitant flows. The balloon occluder prevented this regurgitant flow effectively against a 100/80 mm Hg arterial pressure. In conclusion, this emergency balloon occlusion system is relatively easy to operate and will work efficiently in all possible clinically encountered malfunctions of the rotary blood pump LVAS.

Animals↗
PubMed1992

Aneurysm recurrence following endovascular balloon occlusion.

Endovascular balloon occlusion is an alternative treatment for surgically unclippable cerebral aneurysms. The results of aneurysm occlusion with either a silicone or a latex balloon in a common carotid artery bifurcation aneurysm model are compared to determine which type of balloon was least likely to result in aneurysm recurrence. Five rabbits each underwent endovascular balloon occlusion with either a silicone or a latex balloon, with seven rabbits serving as controls. At 3 months postocclusion, nine of the 10 balloon-treated aneurysms had recurred. The recurrent aneurysm tended to be larger in animals treated with silicone than with latex balloons. A dense fibrotic response was present around the collar of the latex balloons, but no significant fibrotic response was found in the silicone balloon group. This study suggests that with currently available balloons, the initial complete angiographic obliteration of an aneurysm following balloon occlusion should not be interpreted as a cure and that periodic follow-up angiography should be performed.

Aneurysm↗
PubMed1981

Complications and hazards with angiographic occlusion balloon catheters.

Twenty angiographic procedures involving the superior mesenteric artery (SMA) were performed with balloon occlusion catheters in dogs with chronic liver cirrhosis and portal hypertension. The following complications were found: (a) rapid balloon inflation during angiography due to a leak between the two catheter lumens (two cases); (b) failure to deflate a balloon located in the SMA (two cases); (c) balloon detachment intravascularly and during catheter insertion (one case each); and (d) rupture of the SMA (one case). Balloon detachment occurred only with re-used catheters. The safety of angiographic occlusion balloon catheters for general use is questioned. Under no circumstances should catheters be re-used.

Angiography↗
PubMed2005

Temporary balloon occlusion of the common iliac artery: new approach to bleeding control during cesarean hysterectomy for placenta percreta.

A case of placenta percreta was referred at 31 weeks' gestation. We performed a cesarean hysterectomy preceded by placement of occlusive balloon catheters at bilateral common iliac arteries at 34 weeks' gestation. This simple and safe technique provides satisfactory efficacy for control of profuse bleeding during operation, with blood loss estimated at 800 mL.

Adult↗
PubMed2005

Hepatic outflow obstruction created by balloon occlusion of the hepatic vein: induced hepatic hemodynamic changes and the therapeutic applications of hepatic venous occlusion with a balloon catheter in interventional radiology.

Hepatic outflow obstruction created by balloon occlusion of the hepatic vein induces characteristic angiographic findings in the occluded area: prolonged enhancement on hepatogram followed by reversed portal opacification on the hepatic arteriogram and perfusion defect on the arterial portogram. The following induced hepatic hemodynamic changes are suggested: hepatic arterial flow increases, and the portal vein acts as a draining vein with slow reversed flow. These unique hemodynamic changes enhance the effect of hepatic interventional therapies. In transcatheter arterial infusion, increasing hepatic arterial flow and absence of portal inflow can bring about a high concentration of drugs, the presence of which is greatly protracted due to outflow blockage. In transcatheter arterial chemoembolization, reversed portal flow can allow portal embolization in addition to arterial embolization. In microwave coagulation therapy and radiofrequency ablation therapy, decreasing portal flow can cause larger areas of coagulation. Further, the technique of hepatic venous occlusion has potential therapeutic applications.

Catheter Ablation↗
PubMed2001

[Cerebral protection with balloon occlusion during carotid artery stent implantation--first experiences].

PURPOSE: To assess the technical feasibility and the results of cerebral protection with the GuardWire Plus Temporary Occlusion & Aspiration System during carotid artery stenting for high-grade stenosis. PATIENTS AND METHODS: In 20 patients 20 carotid artery stenoses were treated with stent placement under cerebral protection. A contralateral carotid occlusion was an exclusion criteria for the use of the protection device. In all cases only aspiration, but no flushing was used before deflation of the occlusion balloon. In 17 of 20 patients diffusion-weighted (DW-)MRT imaging of the brain was performed before and 24 hours after the procedure. RESULTS: The stent implantation was successfully performed in all patients. In 3 patients neurologic symptoms occurred during the occlusion time. In these 3 patients the symptoms immediately disappeared after deflation of the balloon. In one case there was dilatation of the internal carotid artery at the site of the balloon inflation. In 3 of the 17 DW-MR images new ipsilateral cerebral lesions, in one case a new contralateral lesion occurred after the procedure. CONCLUSIONS: The cerebral protection procedure is technically feasible. The occlusion of the internal carotid artery was not tolerated by all patients. The DW-MR imaging demonstrated cerebral lesions indicating the occurrence of cerebral microemboli during the procedure. Further investigations are necessary to determine if the use of the cerebral protection device will improve the results of the carotid artery stenting for high-grade stenoses.

Aged↗
PubMed1997

Temporary balloon occlusion of the inferior vena cava as an alternative to cardiopulmonary bypass in resection of Wilms' tumour with vena cava extension.

Up to 10% of patients undergoing nephrectomy for Wilms' tumour have tumour thrombus involving the vena cava. A new radiological technique is described utilising a temporary occlusion balloon inserted via an open venotomy of the left internal jugular vein into the retro-hepatic cava to create a bloodless field to facilitate surgery.

Cardiopulmonary Bypass↗
PubMed1999

Use of a balloon occlusion catheter to facilitate transarterial coil embolisation of a patent ductus arteriosus in two dogs.

Two dogs with a history of coughing and exercise intolerance were suspected to have a patent ductus arteriosus (PDA), and the presence of a type III PDA was confirmed by radiography, electrocardiography, ultrasonography and angiography. Transarterial coil embolisation was carried out by using a modified technique. An occlusion balloon catheter was inserted through a femoral vein and placed at the pulmonary side of the ductus before the embolisation coils were put in place. Both dogs remained healthy during a follow-up period of nine months.

Animals↗
PubMedDate not supplied

Clamp before you cut: Proximal control of ruptured abdominal aortic aneurysms using endovascular balloon occlusion--Case reports.

While the mortality rate for elective abdominal aortic aneurysm (AAA) repair has declined over the last several decades, the rate for ruptured abdominal aortic aneurysm (RAAA) has unfortunately remained disturbingly high. Undiagnosed aneurysms may present with little warning until abdominal pain, syncope, and hypotension signify rupture. Fifty percent of patients with ruptured aneurysms die before reaching a medical facility, and their survival is highly dependent on hemodynamic stability at presentation. The degree of rupture containment and comorbid status of the patient determine hemodynamic stability. Endovascular stent grafting has significantly improved perioperative morbidity and mortality rates for elective AAA repair, and some of the same endovascular techniques can be used to obtain proximal control in patients presenting with RAAA. We describe 3 consecutive cases of RAAA where proximal control was obtained using a percutaneously placed, transfemoral aortic occlusion balloon before induction of anesthesia.

Aged↗
PubMed1987

Demonstration of ascending aorta in hypoplastic left heart syndrome with aortic atresia by balloon occlusion aortography.

Balloon occlusion angiography in the descending aorta produced clear retrograde visualization of the hypoplastic ascending aorta and related structures in eighteen neonates with aortic atresia. Transient bradycardia was the only complication observed. It is technically simpler than retrograde cannulation of the aorta via an arteriotomy and should be the method of choice when cardiac catheterization is required in patients with the hypoplastic left heart syndrome.

Aorta↗
PubMed2004

A patient-specific computer model to predict outcomes of the balloon occlusion test.

OBJECT: Balloon occlusion tests (BOTs) are performed to identify patients who are at risk for ischemia and stroke following permanent internal carotid artery (ICA) occlusion. The object of this work was to determine whether patient-specific blood flow modeling can be used to identify patients in whom the BOT would not be tolerated. METHODS: The test was performed in 16 patients who underwent BOT with continuous neurological and electroencephalographic monitoring, followed by a hypotensive challenge. During hypotension a tracer was injected so that single-photon emission tomography (SPECT) scans could be obtained. Each individual brain circulation was modeled using information gained from phase-contrast magnetic resonance (MR) angiography and digital subtraction (DS) angiography, and the predicted effect of the BOT was evaluated. Six patients did not tolerate the BOT; in these patients, decreases in middle cerebral artery (M1 segment) blood flow of 41 +/- 27% (mean +/- standard deviation), anterior cerebral artery (A3 segment) flow of 56 +/- 33%, and posterior cerebral artery (P2 segment) flow of 4 +/- 13% ipsilateral to the site of occlusion were found with modeling; these changes were significantly greater than the percentage of changes measured in the contralateral hemisphere (p < 0.05). Ten patients who tolerated the BOT well had calculated decreases in ipsilateral flows of only 9 +/- 6% for the M1 segment, 12 +/- 40% for the A3 segment, and 17 +/- 21% for the P2 segment during BOT modeling. CONCLUSIONS: A decrease in blood flow in both the ipsilateral M1 and A3 segments that was greater than 20%, calculated by flow modeling of the BOT, was 100% sensitive and 100% specific in identifying patients who could not tolerate the BOT. Blood flow modeling, coupled with DS angiography and noninvasive phase-contrast MR angiography measurements to make calculations patient specific, can be used to identify patients who have an elevated risk of ischemia during the BOT.

Adult↗
PubMed1998

[Open distal anastomosis or aortic balloon occlusion technique during complete aortic arch replacement].

The technique of open distal anastomosis or application of aortic balloon occlusion catheter designed to occlude the descending thoracic aorta have been used in 33 and 19 patients, respectively, to control bleeding during the procedure of distal anastomosis for complete aortic arch replacement with a prosthetic graft. These two techniques allowed us a simple approach to the lesion and the avoidance of clamp injury to the fragile aortic tissue. Open distal anastomosis was applied for 91% patients of operated aortic dissection and all emergent cases, it's duration ranged from 10 to 110 minutes with an average of 58 minutes under 18.2 degrees C of lowest esophageal temperature. On the other hand, aortic occlusion balloon was inserted for mainly true aortic aneurysm patients without an emergency, and helped to maintain the perfusion pressure on a lower part of body around 50 mmHg by the 1550 ml/min in an average of perfusion flow femoral artery under 21.2 degrees C of temperature. The difference of postoperative renal and liver function evaluated by serum enzyme levels of total bilirubin, GOT, GPT, LDH, creatinine and BUN did not reach to statistical significance between the patients using open distal anastomosis and balloon occlusion, however, the incidence of postoperative complication including either renal, liver dysfunction, abdominal problem or paraplegia was significantly higher in the patient group with open distal technique. Either open distal anastomosis or aortic balloon occlusion technique would be appropriately selected according to the patient's characteristics or the condition of aortic disease to be operated.

Aged↗
PubMed1999

Temporary endovascular balloon occlusion of the internal carotid artery with a nondetachable silicone balloon catheter: analysis of technique and cost.

BACKGROUND AND PURPOSE: Temporary balloon occlusion has become a routine and medically accepted technique for the management of patients with aneurysms or intracranial or head/neck tumors. We describe our experience using a nondetachable silicone balloon (NDSB) catheter in 103 endovascular temporary balloon occlusions of the internal carotid artery, with attention focused on technique, complications, and cost. METHODS: Between 1993 and 1998, 103 patients underwent preoperative temporary balloon occlusion testing with a 1.5-mm NDSB catheter. Clinical testing during endovascular blockade was combined with qualitative cerebral blood flow analysis using technetium-99m HMPAO SPECT. Cost-effective analysis was performed, emphasizing cost and complication rates in comparison with those in previously reported series in which multiple types of temporary balloon occlusion catheters were used, predominantly not of the NDSB type. RESULTS: No carotid artery injury or complication, including cerebral infarction due to NDSB use, was encountered. Despite the increased cost of the NDSB catheter system, cost-effective analysis showed up to 40% reduction in cost per quality adjusted life years. CONCLUSION: Temporary balloon occlusion using the NDSB catheter is safe and cost-effective, owing to the low rate of complications.

Aged↗
PubMed2005

[Evaluation of 38 cases of employing aortic occlusion balloon catheter].

BACKGROUND: Aortic occlusion balloon catheter (AOBC), which occludes the descending aorta without thoracotomy, is expected to prevent further blood loss and raise blood pressure (BP). We investigated the effects of AOBC retrospectively. METHOD: AOBC was used in 38 patients for perioperative management only if the BP responded insufficiently despite rapid resuscitation due to massive hemorrhage below the diaphragm. There were 33 trauma cases, and five cases of ruptured abdominal aortic aneurysm. We inserted AOBC via the femoral artery or left common carotid artery in the emergency room(ER) or in the operating room (OR). RESULTS: BP increased for 38.7 +/- 33.9 mmHg following AOBC, with a survival rate of 36%. CONCLUSIONS: In our experience, AOBC was effective for raising BP in patients in hemorrhagic shock.

Adolescent↗
PubMed1999

Embolotherapy of aneurysms under temporary balloon occlusion of the neck. In vitro study of a newly designed eccentric balloon catheter.

RATIONALE AND OBJECTIVES: To test embolotherapy of aneurysms in an in vitro model using standard and specially designed eccentric occlusion balloon catheters for simultaneous delivery of the embolization agent and occlusion of the neck of the aneurysm. METHODS: Two different in vitro set-ups were used: a bifurcational aneurysm and an aneurysm with a straight parent vessel segment, both made from elastic silicone and glass. Each model was exposed to a pulsating perfusion. The effluent was collected and filtered. For the bifurcational aneurysms, commercially available occlusion balloon catheters with a working channel exiting at the tip were used. For the aneurysms with straight parent vessel, the catheters were modified so that the balloon opened eccentrically. The working channel of the catheter led to a side hole, which was located where the balloon membrane was fixed to the catheter shaft. The aneurysms were filled with coils, ethibloc, or hydrogel, and with coils combined with ethibloc or hydrogel, while the expanded balloon occluded the neck. RESULTS: Embolization of aneurysms under balloon occlusion of the neck was technically feasible with the catheter devices. Dense packing with coils was possible in all cases without coil dislocation, but unfilled interspaces remained between the coil wires. Best filling was achieved with ethibloc or hydrogel alone or in combination with coils. During the filling procedure, there was no distal embolization of the liquid agents. However, after balloon deflation, considerable amounts of hydrogel or ethibloc were washed out from the aneurysm. CONCLUSIONS: The results suggest that balloon occlusion of the neck allows compact filling and minimizes the risk of dislocation in coil embolotherapy of aneurysms. In nonbifurcational aneurysms, the eccentric balloon catheter seems to be suitable for this treatment concept. Although liquid agents may be safely delivered into the aneurysm under balloon protection, their considerable washout rate after balloon removal requires further refinements of the technique before clinical application is advisable.

Catheterization↗
PubMed1993

Superiority of balloon occlusion arteriography to reactive hyperemic arteriography in visualization of distal lower limb vessels.

Balloon occlusion arteriography was performed in 38 lower limbs; reactive hyperemic arteriography was also performed in 16 of these limbs. To assess the safety and utility of this technique the balloon occlusion arteriograms of all 38 patients were reviewed retrospectively by a vascular surgeon and vascular radiologist who were unaware of the patient's identity and ultimate treatment. After the arteriograms were reviewed and the outflow vessels identified, a decision was made regarding operability and optimal recipient vessel for distal bypass. Twenty-two of the 38 patients underwent balloon occlusion arteriography only, and 21/22 (95.5%) of these patients only had studies deemed adequate for surgical planning. Twelve of the 16 (75%) patients underwent both reactive hyperemic arteriography and balloon occlusion arteriography; potential distal outflow vessels not seen on reactive hyperemic arteriograms were observed on balloon occlusion arteriograms. In only 4/16 (25%) patients the balloon occlusion arteriograms did not yield additional information. No complications were associated with this technique. Approximately 8.5 g of iodine per run is used for balloon occlusion arteriography compared with approximately 37 g of iodine per run for reactive hyperemic arteriography. Balloon occlusion arteriography is a safe and accurate adjunctive technique that can be used when identification of lower limb vessels is critical.

Adolescent↗