J NeuroIntervent Surg doi:10.1136/neurintsurg-2012-010610
  • Hemorrhagic stroke
  • Original research

Addressing challenges in 4 F and 5 F arterial access for neurointerventional procedures in infants and young children

  1. Darren B Orbach2,3
  1. 1Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2Harvard Medical School, Boston, Massachusetts, USA
  3. 3Neurointerventional Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr D B Orbach, Neurointerventional Radiology, Boston Children's Hospital, 300 Longwood Avenue, CB 1113, Boston, MA 02115, USA; darren.orbach{at}
  • Received 28 November 2012
  • Revised 11 February 2013
  • Accepted 12 February 2013
  • Published Online First 6 March 2013


Background Among the technical challenges involved in safely performing neuroendovascular procedures in infants are limitations on the size of femoral arterial access catheters. Restricting groin access to 4 F and 5 F systems constrains the range of procedures that can potentially be performed.

Methods and Results We present here a consecutive series of transfemoral angiographic procedures in children with no permanent and one transient case of groin morbidity related to femoral access. We illustrate two strategies for using 4 F and 5 F systems for interventions in a manner that enables such techniques as balloon assisted coil embolization and the deployment of triaxial catheter systems to be used.

Conclusions Extremely low groin morbidity is achievable using rigorous parameters around femoral catheterization in children. With creative approaches to working within the limitations of the access vessel size, complex endovascular neurointerventions are possible, even in the youngest infants.



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