Microcatheter navigation using a large compliant balloon placed in a cortical vein during transvenous access

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In a Video technique demonstration / Case report Noda et al. from:

  • Neuroradiologie Interventionelle, CHU Limoges, Limoges, France
  • Neurosurgery, NTT Medical Center Tokyo, Shinagawa‑ku, Japan
  • Radiology Department, Universiti Kebangsaan Malaysia, Fakulti Perubatan, Cheras, Malaysia
  • Published inthe Journal of NeuroInterventional Surgery

with the purpose to demonstrate feasibility and safety of using a large compliant balloon positioned in a cortical vein to support microcatheter navigation for transvenous embolization of a brain AVM They concluded that the large compliant Copernic RC balloon provided stable “buttress” support in a cortical draining vein, enabling safe and successful microcatheter cannulation during TVE in a challenging bAVM case, without complications 1).

This video-based single‑case technique report suffers from severe limitations:

  • n=1 restricts external validity—no statistical support or comparison with standard microcatheter techniques
  • No quantitative bench testing or phantom models to define force thresholds, risks of venous rupture, or balloon‑catheter interaction
  • Balloon in cortical veins raises significant safety concerns: potential for endothelial injury, venous thrombosis, or rupture—no monitoring or follow‑up imaging provided
  • Technique complexity—introducing a compliant balloon into fragile veins may add procedural risk not fully acknowledged
  • No long‑term clinical outcomes documented; absence of angiographic follow‑up to confirm AVM obliteration or highlight delayed venous injury undermines claims
  • Lack of multi-operator reproducibility or ergonomic feasibility—unclear learning curve or required expertise

Final Verdict

This contribution is a rudimentary proof‑of‑concept overshadowed by major safety, validity, and reproducibility concerns. Valuable as an exploratory video, but not robust evidence.

Takeaway for Neurosurgeons

A novel balloon-assisted approach shows technical promise in select TVE scenarios—but red flags abound: extremely cautious use, rigorous safety protocols, and comparative studies are mandatory before adoption.

Bottom Line

One-case video demonstration only; attractive in concept but currently lacks scientific rigour and safety validation—far from practice-changing.

Numeric Rating (0–10)

2/10 – Innovative idea, but unjustified risk and devoid of follow‑up or comparative evidence.

Citation

1)

Noda R, et al. Microcatheter navigation using a large compliant balloon placed in a cortical vein during transvenous access. *J Neurointerv Surg*. 2025 Jun 24. doi:10.1136/jnis‑2025‑023596.

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