Background and Significance We describe a method by which to efficiently and atraumatically achieve distal positioning of a flexible guiding catheter beyond extreme cervical tortuosity using a hypercompliant temporary occlusion balloon.

Methods A retrospective review of a prospective neuroendovascular database was used to identify cases in which a hypercompliant balloon catheter (Hyperform or Hyperglide, ev3/Covidien, Irvine, CA; Scepter or Scepter XC, MicroVention, Tustin, CA) was used to achieve distal positioning of a flexible guiding catheter (Navion, ev3/Covidien, Irvine, CA; Neuron, Penumbra Inc., Alameda, CA). After achieving a stable guiding sheath position within the proximal cervical carotid artery, a hypercompliant balloon catheter was manipulated beyond the tortuous cervical internal carotid segment into the distal carotid artery. The balloon was then inflated to anchor it distally within the cavernous segment of the ICA. Then the guiding catheter was advanced beyond the tortuous cervical segment, over the balloon catheter, as gentle counter traction was applied to the balloon.

Results Balloon-assisted guiding catheter placement was used to perform endovascular treatments of twelve anterior circulation aneurysms. One patient underwent coiling alone. Five patients underwent balloon assisted coiling. One patient underwent balloon and stent assisted coil embolisation. Four patients with five carotid aneurysms (one with bilateral carotid aneurysms) underwent vascular reconstruction with the pipeline embolisation device. All patients had tortuosity of the carotid system. Three patients had findings consistent with cervical carotid fibromuscular dysplasia. The technique was successful each time it was attempted. No parent artery dissections or catheter-induced vasospasm were noted in any case.

Discussion Hypercompliant balloon catheters can be reliably used to facilitate safe and rapid distal positioning of flexible guiding catheters beyond severe cervical tortuosisty.

Disclosures D. Fiorella: 1; C; MicroVention, Siemens Med Systems. 2; C; ev3/Covidien, JNJ/Codman, CVSL. 6; C; Codman. L. Peeling: None