The Barrel Vascular Reconstruction device (Medtronic) is one of the newest offerings for the treatment of intracranial bifurcation aneurysms. Since receiving the CE mark in January of 2014, the device has been used throughout Europe. Now, Tufail Patankar (Consultant Interventional Neuroradiologist, Leeds Teaching Hospitals NHS Trust, Leeds, UK) speaks to NeuroNews about his experience with the Barrel vascular reconstruction device in his own practice, and explains why there is almost no learning curve associated with its use.
What is the design of the Barrel Vascular Reconstruction device?
The Barrel vascular reconstruction device is designed similar to a balloon assisted approach with stenting providing coil containment and branch vessel patency with one device. The barrel section of the device herniates over the ostium and reduces the aneurysm neck to support coiling.
What are its unique characteristics?
The unique hinge technology allows the barrel portion of the stent to be used as a neck reconstruction device in bifurcation aneurysms.
It is deliverable through 0.021” microcatheters and the fact that it is 100% resheathable and electrolytically detachable makes it an easy tool for stent assisted coiling.
Can you briefly describe a case in which you have used the Barrel device?
One of the cases I was impressed by the stent was a small, wide-neck, approximately 2mm ruptured aneurysm at the origin of perforator at basilar termination. I attempted a balloon but was unable to successfully deploy the coil within the aneurysm. The Barrel stent bulged in the eccentric perforator aneurysm neck to cover and reconstruct the neck to coil the aneurysm.
What are the benefits of the Barrel device that you have seen thus far?
- Good alternative to Y or T stenting in complex wide neck aneurysms
- 100% resheathability
- Electrolytically detachable
- Good visibility
- Easy to deploy
- No shortening of device
- Regular antiplatelet regimen needed only.
Is there a learning curve associated with the use of the device?
That is the best thing about the device. There is no need for proctoring and there is no learning curve with the use of the device. If you are able to use the Solitaire stent (Medtronic), then you can use a Barrel stent.