Report Library

An intrathecal pump is an implantable medical device that delivers medication to the intrathecal space surrounding the spinal cord. The drug pump reduces the reliance of patients on oral or intravenous medications and can minimize the associated side effects while controlling their symptoms. Lower doses of medications are generally required since the drug delivery is more targeted. Before a pump is implanted into the patient, the therapeutic effect of the intrathecal opioid therapy is tested with an external pump; the pump is not implanted if there are no clear and satisfactory effects in the trial application.

Balloon occlusion devices have inflatable balloon devices at their distal end which can be expanded to occlude an artery. Balloon occlusion devices serve a number of purposes in neurovascular procedures. They can be used to assist detachable coil procedures, similarly to stents, however these devices are temporary. In these cases they are being used to aid in the treatment of aneurysms, AVMs or fistulas. When using detachable coils there is a risk of the coils blocking flow of the parent artery if they occlude the lumen of the artery as well. In order to minimize this risk, the balloon is inflated inside the parent artery prior to the insertion of coils so that they can be packed tighter inside the aneurysm without the danger of them protruding into the lumen. A study looking at this technique in anterior aneurysms found that there was a lower complication rate with balloon assisted coiling in comparison to coiling alone however other studies have found the opposite therefore further studies are required. In some cases, balloon catheters can also be used for the placement of stents. There are a number of factors that could impact the choice to use this device for aneurysm treatment such as the clinical situation, physician’s preference, and the morphology of the aneurysm. It is worth noting that the ASP of these devices is considerably less than stents which could impact device preference as well.

Liquid embolics currently on the market include N-butyl cyanoacrylate (NBCA) (TRUFILL®) and an ethylene-vinyl alcohol copolymer (Onyx®). These agents are injected through microcatheters and act like glue in abnormal blood vessels. When they contact blood they solidify and obstruct the vessel lumen therefore blocking the flow of blood through malformed blood vessels and reducing the risk of rupture. The surgeon performing the procedure must flush the catheter before and after injecting the NBCA to prevent the liquid agent from sticking to the catheter. Thus this procedure requires a highly skilled physician. This is often done prior to the removal of these vessels in order to simplify the surgical procedure.