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Case series
Use of a next-generation multi-durometer long guide sheath for triaxial access in flow diversion: experience in 95 consecutive cases
  1. Li-Mei Lin1,
  2. Matthew T Bender2,
  3. Geoffrey P Colby2,
  4. Narlin B Beaty2,
  5. Bowen Jiang2,
  6. Jessica K Campos2,
  7. Judy Huang2,
  8. Rafael J Tamargo2,
  9. Alexander L Coon2
  1. 1Department of Neurosurgery, University of California, Irvine School of Medicine, UC Irvine Medical Center, Orange, California, USA
  2. 2Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
  1. Correspondence to Dr Li-Mei Lin, Department of Neurosurgery, University of California, Irvine School of Medicine, UC Irvine Medical Center, 101 The City Drive South, Building 200, Suite 210E, Orange, California, USA; limei.lin{at}


Background Intracranial access techniques in modern neurointerventions have shifted towards more robust access platforms. The long guide sheath is one of the building blocks of triaxial systems used in intracranial embolizations. Here we present our experience with the AXS Infinity LS long sheath in the triaxial platform for the implantation of the Pipeline embolization device (PED).

Methods We retrospectively identified patients who underwent PED Flex treatment with the AXS Infinity LS at a single institution. Procedural data collected included parent artery tortuosity, patient demographics, vasodilator use, aneurysm characteristics, equipment utilized, and catheter-related complications.

Results A total of 95 cases were completed using the AXS Infinity LS for the triaxial platform foundation in PED Flex treatment of cerebral aneurysms. Mean patient age was 56.2±12.2 years (range 21–86). Average aneurysm size was 6.9±6.2 mm (range 1–38). There were 89 anterior circulation cases (94%) and 6 posterior circulation cases (6%). Significant cervical ICA tortuosity was present in 11/89 (12%) and moderate to severe cavernous ICA tortuosity was present in 29/89 (33%). Mean fluoroscopy time was 40.0±19.8 min. In 14/95 cases (15%), vasospasm prophylaxis or treatment with intra-arterial verapamil infusion was performed. Catheter access-related complications included asymptomatic iatrogenic dissection in one case (1%) from the distal intracranial catheter and groin hematoma in one case (1%). No parent vessel wall abnormalities were visualized in the region of the Infinity long sheath on final control angiography in all 95 cases.

Conclusion The AXS Infinity LS is the newest long guide sheath available for modern neurointerventional procedures. We have shown its utility in augmenting the triaxial access platform in PED Flex cases by providing enhanced distal tip trackability with added support in the aortic arch and proximal great vessels.

  • aneurysm
  • endovascular
  • flow diversion
  • guide catheter
  • distal access
  • pipeline embolization device

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  • Contributors LML drafted the manuscript and critically revised the manuscript for important intellectual content. NBB, JKC, MTB and BJ assisted with the data collection and analysis. GPC performed treatment procedures and assisted in critically revising the manuscript. JH and RJT crucially reviewed the important intellectual content of the manuscript. ALC performed treatment procedures and critically revised the important intellectual content. All authors read and approved the final manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests ALC is a proctor for the Woven Endobridge (WEB) device (Sequent Medical, Aliso Viejo, California, USA), a proctor for the Surpass device (Stryker Neurovascular, Fremont, California, USA) and a consultant for Stryker Neurovascular, a proctor for the Pipeline Embolization Device (Medtronic Neurovascular, Irvine, California, USA) and a consultant for Medtronic, and a proctor for the FRED device (MicroVention, Tustin, California, USA) and consultant for MicroVention. GPC is a consultant for Medtronic, MicroVention and participates in clinical trials for Medtronic and Stryker. LML is a proctor for the Pipeline Embolization Device (Medtronic Neurovascular), a consultant for MicroVention and participates in clinical trial for Stryker. The other authors have no conflict of interest. No author received financial support in conjunction with the generation of this submission.

  • Ethics approval Johns Hopkins Institutional Review Board.

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

  • Data sharing statement There are no additional unpublished data from this study.