Temporary subclavian steal to reduce intraprocedural embolic risk during detachable balloon occlusion of vertebrobasilar aneurysms: technical note with two case reports

Journal of Endovascular Surgery : the Official Journal of the International Society for Endovascular Surgery
D A EckardP P Han

Abstract

Unintentional intracerebral embolization is a serious, ever present threat during neurointerventional procedures. We have devised a method to reduce this intraprocedural risk in vertebral artery interventions by creating a temporary subclavian steal. For this technique, a temporary balloon occlusion catheter is advanced into the proximal subclavian artery via a femoral artery approach, while a second introducer catheter is passed into the target vertebral artery via an axillary artery access. The temporary occluding balloon is then inflated within the proximal subclavian artery, establishing a subclavian steal that diverts blood flow into the arm. Permanent balloon occlusion of the vertebral artery can then be accomplished without fear of intracerebral embolization. Two patients with vertebrobasilar junction aneurysms were successfully treated with detachable balloon embolization using this cerebral protection technique. The permanent occlusion balloons were easily passed through the introducer catheter without difficulty despite reversed vertebral artery flow. No complications were encountered, and the aneurysms were successfully occluded in both patients. Temporary subclavian steal can be easily created to reduce the risk of ...Continue Reading

Citations

May 1, 1996·Surgical Neurology·S LeivoM Vapalahti
Dec 31, 1997·Journal of Neurosurgery·G J RedekopW B Woodhurst
Jun 6, 2000·Journal of Neurosurgery·R F Del Maestro
Mar 9, 2002·Journal of Neurosurgery·Steen FridrikssonJan Hillman
Mar 31, 2005·Journal of Neurosurgery·Hisham Al-KhayatDuke Samson

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