Balloon-assisted coiling of intracranial aneurysms using the Eclipse 2L double lumen balloon

Abstract

Background: Eclipse 2L is a new double lumen balloon microcatheter for neurovascular use, with several design features that separate it from previous generation devices. We aimed to report our initial experience of balloon-assisted coiling of intracranial aneurysms using the Eclipse 2L balloon.

Materials and methods: Retrospective single-center review of patients who underwent balloon-assisted coiling with the Eclipse 2L balloon, for ruptured or unruptured intracranial aneurysms between 1 June 2016 and 31 December 2018. Cases with adjunctive use of stents and recurrences of previously embolized aneurysms were excluded. Patient files were used to extract aneurysm characteristics, complications, immediate and long-term results.

Results: We identified 120 patients with 126 aneurysms, of which 83 (65.8%) unruptured. Average aneurysm size was 5.9 mm (standard deviation 3.2 mm), with a dome-to neck-ratio of 1.7 (SD 0.6). Most aneurysms (79.3%) were wide necked. Immediate angiographic exclusion (Raymond-Roy grade I-II) was obtained in 95.1% of cases (81.7% grade I and 13.4% grade II). Procedural morbidity was 3.2% with no procedural mortality. Follow-up imaging was available for 115 aneurysms (91.2%). After an average follow-up period of 8.9 months (SD 7.3 months), 96.5% of aneurysms presented class I-II occlusion. Two aneurysms (1.7%) were retreated during follow-up.

Conclusion: Balloon-assisted coiling using the Eclipse 2L double lumen balloon is feasible for aneurysms in a wide range of locations in the anterior and posterior circulation. The angiographic results and complication rates compare favorably with previously published studies.

Keywords: Double lumen balloon; coil; embolization.

Figure 1.

Design characteristics of the Eclipse 2L balloon. (a) Schematic representation of the flat catheter concept. The inflation/deflation lumen is parallel to the guidewire lumen, leading to an overall oval shape. (b) All versions have a preshaped 45° tip to improve trackability in tortuous anatomy. The balloon has three radiopaque markers, one at the tip and two at the distal and proximal extremities of the balloon. Source: reproduced with permission from Balt International.

Figure 2.

Illustrative case 1. An elderly patient presented with subarachnoid hemorrhage due to a ruptured 7 mm posterior communicating aneurysm (a). The aneurysm was treated by balloon-assisted coiling using a 6 × 9 mm Eclipse 2L balloon navigated in the posterior communicating artery (b and c), with complete occlusion demonstrated on the final angiographic run (d). The balloon’s compliance allowed it to adjust to the varying caliber and the acute angle between the carotid and the posterior communicating artery.

Figure 3.

Illustrative case 2. Unruptured 7.4 mm basilar tip aneurysm (a). Due to marked tortuosity in the proximal part of both vertebral arteries, it was impossible to place a guiding catheter high enough to support navigation of both a balloon and a microcatheter for balloon-assisted coiling. For this reason, a 6 × 9 mm Eclipse 2L balloon was navigated across the aneurysm neck from the left internal carotid via the posterior communicating artery (b and c), for balloon-assisted coiling (d). The final coil mass is shown on (e) with complete aneurysm exclusion demonstrated on the last run (f). Due to its flexibility and trackability, it was possible to navigate this double lumen balloon via a relatively small posterior communicating artery.