Pentaxial access platform for ultra-distal intracranial delivery of a large-bore hyperflexible DIC (distal intracranial catheter): A technical note

Interdisciplinary Neurosurgery

卷:6

Geoffrey P. Colby¹  Rajiv R. Iyer²  Alexander L. Coon²  Bowen Jiang²  Judy Huang³  Rafael J. Tamargo⁴  Li-Mei Lin⁵ 

[1] Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Zayed 6115C, Baltimore, MD 21287, United States;

[2] Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Zayed 6115E, Baltimore, MD 21287, United States;

[3] Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Zayed 6115F, Baltimore, MD 21287, United States;

[4] Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Zayed 6115G, Baltimore, MD 21287, United States;

[5] Department of Neurosurgery, University of California, Irvine School of Medicine, UC Irvine Medical Center, 101 The City Drive South, Building 200, Suite 210E, Orange, CA 92868, United States;

关键词: Aneurysm;    Endovascular;    Flow diversion;    Guide catheter;    Distal access;    Pipeline embolization device;    Surpass;    WEB;    Navien;   

DOI  :  10.1016/j.inat.2016.06.002

来源: DOAJ

【 摘 要 】

Background: Intracranial access techniques in modern neurointervention are shifting towards more robust access platforms. We present in this report a novel method of navigating a 5 French distal intracranial catheter (DIC) deep within the intracranial circulation in an atraumatic fashion via a pentaxial access system.Methods: We retrospectively reviewed all neurointerventions performed at two author institutions identifying all aneurysm treatments where the pentaxial system was used to build the catheter support for intracranial positioning of a 5 French DIC.Procedural data collected include parent artery tortuosity, use of vasodilator, intra-procedural DIC position, and peri-procedural complications.Results: The pentaxial access platform provided ultra-distal intracranial navigation of the 5 French DIC in the following 11 neurointerventions for treatment of anterior circulation aneurysms: Pipeline embolization device (PED) for anterior communicating artery (ACom) aneurysm, n = 2; surpass for large internal carotid artery (ICA) aneurysm, n = 4; Woven EndoBridge (WEB) device for ACom aneurysm, n = 5. Mean patient age was 55 ± 11 years (range 40–75 years). Mean aneurysm size was 6.7 mm ± 3.8 mm (range 2–16 mm). Mean fluoroscopy time was 29 ± 16.7 min. Intra-procedural DIC positions achieved included supraclinoid ICA (n = 6), M1 (n = 4), and A1 (n = 1). No significant catheter-related complications occurred.Conclusion: Distal intracranial catheters can achieve ultra-distal intracranial positions safely with the pentaxial access platform. This technique is a near no step-off, atraumatic method of navigating a DIC in a stepwise fashion over de-escalating smaller diameter catheters via a microwire. Familiarity with catheter specifications including diameters and length is essential for the success of this system.

【 授权许可】

Unknown