1. Double lumen remodeling balloon: New technique for treatment of MCA bifurcation aneurysm Kadziolka K, Leautaud A., Estrade L., W. Mustafa, Pierot L. CHU REMIS Interventional Neuroradiology Department France

2. New technology As medical technology advances such as stenting, remodeling, an increasing number of intracranial aneurysms are being addressed for EVT.

3. Aneurysm morphology  MCA large, bifurcation aneurysms are technically challenging due to the complex anatomy.  Bifurcation aneurysms are often wide necked and incorporate the origin of arterial branches in the aneurysm broad base.

4. Endovascular therapeutic options  Remodeling with use of hyper compliant balloon.  Double balloon technique ( kissing balloon)  Distal round balloon technique  Stent with or without balloon  „Y” stenting ( dual antiplatelet premedicatio )  Double lumen distal remodeling balloon?

5. Distal round balloon technique v

6. Dual lumen balloon microcatheter

7. Primary experience with use of novel double lumen balloon ASCENT 4 x 7 mm Micrus Endovascular Corp, San Jose, California, USA

8. Balloon Catheter Technical Specification  Guidewire compatibility ≤.014”  Tip length distal to balloon 3 mm  Inner lumen diameter.0170”  Outer diameter 2.9F  Marker band 3 cm from distal tip allows delivery of embolics (Ascent 4x7 mm)  Compatible with DMSO  Guiding catheter compatibility,050” minimum ID

9. Patients and Methods A 60-year-old male presented with unruptured left MCA bifurcation aneurysm measuring 11×7 mm with neck 4 mm. Dome to neck ratio 2.5. Both parents suffered from ruptured aneurysm subarachnoid hemorrhage.

10. Periprocedural Medication  Systemic heparinisation: 50 IU/kg bolus infusion followed by 1500 IU/hour.  ASA 250 mg IV.  Systemic heparinisation prolonged for 24 hours.

11. Endovasculare procedure

13. Results

14.  Clinical outcome at discharge was unchanged.  Anatomic angiographic outcome appears as residual neck.

15. Follow-up Examination  Follow up MRI after 3 months.  DSA follow-up at 6 months after the treatment

16. Follow-up Examination

17.  Anatomic angiographic outcome appears as complete occlusion.

18.  Embolisation of the aneurysm with dome to neck diameter ≥ 6mm /3 mm distal microcatheter tip/  Rigidity of the double lumen catheter  Cigar ellipsoidal shape instade of round more spherical Technical difficulties and limitations

19. Our recomendations for use of Ascent double lumen balloon  New compliant guide catheters 6F or coaxial guiding platform.  Microwire. 014" rather then smaller

20. Conclusion  Double lumen balloon provides a means to acheive reconstruction of complex mca bifurfation aneurysm and can be an alternative to double balloon(kissing)technique or “Y” stenting for some selective bifurcation aneurysms.  Due to development of new endovascular devices treatment of mca bifurcation becomes safer, feasible and durable.