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Use of the Outreach distal access catheter as an intracranial platform facilitates coil embolization of select intracranial aneurysms: technical note
  1. Erik F Hauck1,2,
  2. Rabih G Tawk1,2,
  3. Nicholas S Karter1,2,
  4. Mandy J Binning1,2,
  5. Alexander A Khalessi1,2,
  6. Sabareesh K Natarajan1,2,
  7. L Nelson Hopkins2,3,
  8. Elad I Levy2,3,
  9. Adnan H Siddiqui2,3
  1. 1Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
  2. 2Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York, USA
  3. 3Departments of Neurosurgery and Radiology and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
  1. Correspondence to Dr A H Siddiqui, University at Buffalo Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, 3 Gates Circle, Buffalo, NY 14209, USA; asiddiqui{at}ubns.com

Abstract

Objective The Outreach distal access catheter (DAC; Concentric Medical, Mountain View, California, USA) has been designed to assist the Merci device (Concentric Medical) with clot retrieval in the setting of acute stroke. Its application for coil embolization of intracranial aneurysms was investigated.

Methods Between December 2008 and January 2010, 150 aneurysms were treated with endovascular methods. In 18 cases of small aneurysms and/or increased parent vessel tortuosity, the DAC was used for additional support. Merits and complications related to the use of this catheter are reviewed.

Results The mean aneurysm size was 7.1 mm (range 3.5–25). In each case, the DAC was used as an intracranial platform catheter in close proximity to the target aneurysm. This catheter (outer diameter 3.9 or 4.3 French) increased the stability and reduced the redundancy of the microcatheter. As a result, handling and control of the microcatheter were improved. In three cases, the coiling procedure could not be completed because of difficulties not related to the DAC. Aneurysms in the remaining patients were treated successfully with complete (n=12) or near complete (n=3) angiographic occlusion.

Conclusion For smaller or distal intracranial aneurysms with difficult access, use of the DAC as an additional platform in close proximity to the target aneurysm subjectively enhanced microcatheter control and safety.

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Footnotes

  • Competing interests LNH receives research study grants from Abbott (ACT 1 Choice), Boston Scientific (CABANA), Cordis (SAPPHIRE WW) and ev3/Covidien Vascular Therapies (CREATE), and a research grant from Toshiba (for the Toshiba Stroke Research Center); has an ownership/financial interest in AccessClosure, Boston Scientific, Cordis, Micrus and Valor Medical; serves on the Abbott Vascular Speakers' Bureau; receives honoraria from Bard, Boston Scientific, Cordis and from the following for speaking at conferences: Complete Conference Management, Cleveland Clinic and SCAI; receives royalties from Cordis (for the AngioGuard device); serves as a consultant to or on the advisory board for Abbott, AccessClosure, Bard, Boston Scientific, Cordis, Gore, Lumen Biomedical, and Toshiba; and serves as the conference director for Nurcon Conferences/Strategic Medical Seminars LLC. EIL receives research grant support (principal investigator: Stent-Assisted Recanalization in acute Ischemic Stroke, SARIS), other research support (devices) and honoraria from Boston Scientific and research support from Codman and Shurtleff, Inc and ev3/Covidien Vascular Therapies; has ownership interests in Intratech Medical Ltd and Mynx/Access Closure; serves as a consultant on the board of scientific advisors to Codman and Shurtleff, Inc; serves as a consultant per project and/or per hour for Codmann and Shurtleff, Inc, ev3/Covidien Vascular Therapies and TheraSyn Sensors, Inc; and receives fees for carotid stent training from Abbott Vascular and ev3/Covidien Vascular Therapies. EIL receives no consulting salary arrangements. All consulting is per project and/or per hour. AHS has received research grants from the National Institutes of Health (co-investigator: NINDS 1R01NS064592-01A1, Hemodynamic induction of pathologic remodeling leading to intracranial aneurysms) and the University at Buffalo (Research Development Award); holds financial interests in Hotspur, Intratech Medical, StimSox, and Valor Medical; serves as a consultant to Codman & Shurtleff, Inc., Concentric Medical, ev3/Covidien Vascular Therapies, GuidePoint Global Consulting, and Penumbra; belongs to the speakers' bureaus of Codman & Shurtleff, Inc. and Genentech; serves on an advisory board for Codman & Shurtleff; and has received honoraria from Abbott Vascular, American Association of Neurological Surgeons' courses, an Emergency Medicine Conference, Genentech, Neocure Group LLC, and from Abbott Vascular and Codman & Shurtleff, Inc. for training other neurointerventionists in carotid stenting and for training physicians in endovascular stenting for aneurysms. AHS receives no consulting salary arrangements. All consulting is per project and/or per hour.

  • Ethics approval The institutional review board at the University at Buffalo approved the study, and a standard Health Insurance Portability and Accountability Act (HIPAA) compliant protocol was followed.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Unlabeled use of products The use of the distal access catheter (DAC, Concentric Medical) for the treatment of intracranial aneurysms is considered an off-label United States Food and Drug Administration application because this catheter has specifically been designed to work with the Merci retrieval system (Concentric Medical) to aid in clot removal.

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