The MO.MA device a ballon catheter,
used as guide catheter,
which is located in the CCA at the beginning of intervention.
It precises a 9F introducer sheath in femoral artery to assure the acces.
The device is a single catheter system (usable length of 95 cm) integrating the functional aspects of cerebral protection and a guiding sheath to perform stent implantation and removal of debris by blood aspiration.
Antegrade and retrograde blood flow cessation is achieved by proximal balloon occlusion of the CCA and distal balloon occlusion of the external carotid artery (ECA),
respectively.
The two compliant balloons,
which can be independently inflated,
are mounted on the distal portion of the shaft.
The balloons are sized to fit a reference vessel diameter of the CCA from 5 to 13 mm and a reference vessel diameter of the ECA from 3 to 6 mm.
The working channel serves as a guiding catheter and blood aspiration lumen.
The exit-port of the working channel is located between the two balloons allowing access to the ICA.
The intervention protocol used in our center is as follows:
- Femoral puncture by Seldinger technique and placement of vascular closure system Perclose Proglide (Abott vascular),
that remains ready to use until the end of intervention.
- Placement of 9F introducer sheath.
- Catheterisation of CCA with 4F JB diagnostic catheter (Cordis Johnson and Johnson) and pretreatment angiographic series.
- Catjeterisation of ECA.
- Placement of rigid Exchange guide 0.035” (amplatz Cook).
- Exchange of diagnostic catheter to MO.MA device,
leaving the distal balloon in ECA and proximal balloon in CCA.
- Slow inflation of the ECA and CCA balloons,
observed under fluoroscopy,
until occlusion was indicated by the change in balloon shape from circular to cylindrical.
- Predilatation of the lesion with balloon angioplasty (optional and left to operator discretionç),
stent deployment and postdilation to complete the treatment.
- Aspiration of 60 cc (3 syringes of 20 cc) of blood with the last 20 cc filtered through a 40 lm filter to evaluate for atherothrombotic debris.
If debris was noted,
additional aspiration was completed until no further debris was visible.
- Restoration of antegrade blood flow was then reestablished by deflation of the MO.MA device balloons (ECA balloon first and secondly CCA balloon).
- Gently MO.MA device withdrawal,
passing the tip of catheter placed in ECA between the stent and the wall of the vessel.
- Introducer sheath.withdrawal and vascular closure with perclose proglide.
The indications accepted in our centre to use MO.MA device as protection system in ASC are:
- Critical stenosis or brindle plaque which do not allow crossing with conventional distal filters.
- Severe arterial tortuosity,
distal or proximal to carotid bulb.
- Functional circle of Willis which ensures colateral flow during clamping with balloons.
- Avoid general anaesthesia,
in order to permanent neurological examination of the patient.