LAUSR

OBJECTIVE Balloon remodeling micro-catheters are essential in assisting endovascular coiling of brain aneurysms but the performance and pressure requirements of different balloon types when used in aneurysmal defects are currently unknown. METHODS We used Tinkercad (Autodesk, Montreal, Quebec) to create model vessels with aneurysmal defects and 3D printed these designs with PLA using the Ultimaker2 (Ultimaker, Geldermalsen, Netherlands). We constructed a pressurized box capable of reaching physiologic pressures that housed our vessels and then tested compliant remodeling balloons under fluoroscopy from 3 manufacturers: Hyperglide (Medtronic), Transform (Stryker) and Scepter (Microvention). Each balloon was inflated to a nominal and supranominal point at each defect and at each inflation, the maximum diameter of the balloon and internal balloon pressure was recorded. The Phillips Intellivue (Phillips, Amsterdam, Netherlands) monitor was adapted for internal balloon pressure monitoring. A multivariate linear regression analysis was performed to model balloon compliance (balloon diameter divided by pressure). RESULTS Multivariate regression modelling demonstrated the Scepter balloon had significantly greater compliance compared to both the Hyperglide and Transform balloons (p<0.001). In addition, we found that Scepter balloons had higher compliance in larger defects compared to the other types of balloons and performance differences based on vessel size. CONCLUSION Scepter balloons require less pressure compared to their counterparts to adequately deform through model defects, specifically in larger aneurysm necks in smaller vessel diameters. This result could inform operators of optimal balloon type and size when trying to minimize balloon pressure in fragile brain aneurysms.