Introduction/Purpose Time is of the essence when it comes to restoring blood flow to the brain. With the complexity of the patient’s vascular anatomy due to aortic arch configuration, great vessel angle of origin and degree of tortuosity as well as severity of vessel calcifications, choosing from different shape insert catheters is crucial to navigate the guide catheter into the target vessel as successfully and quickly as possible. A 5F Neuron Select SIM-shape catheter is one of these available insert catheters. Formation of the catheter can be performed over-the-wire at the iliac bifurcation or across the left subclavian artery. Alternatively, the catheter can be formed using a forward push-and-twist technique from the proximal descending aorta across the aortic arch. We aimed to investigate if such a maneuver in the emergency setting is safe, feasible and with and with an acceptable rate of non-target embolic strokes given the twist-push maneuver across the origin of the great vessels.

Materials and Methods We retrospectively reviewed our prospectively maintained stroke database between September 2021 and August 2022 and identified all patients in whom a 5F Neuro Select SIM-shape catheter was used to navigate the guide catheter into the target vessel, either for mechanical thrombectomy or carotid stenting. Patient and procedural information was collected. Postprocedural MRI imaging (when available) was reviewed.

Results A total of 19 patients (11 females) were identified. Patient mean age was 77 years (range 66-96 years). Baseline mRS ranged from 0-4 (median 0). Mean NIHSS was 14 (range 0-30). Nine patients received intravenous thrombolytics. Most patients had a type 2 aortic arch configuration (n=9), followed by Type 1 and type 3 configurations (n=4 each). One patient had a bovine-type aortic arch. Atherosclerotic changes along the aortic arch were none/minimal in 5 cases, mild in 7 cases, moderate in 4 cases and severe in2 cases. Atherosclerotic changes along the cervical vessels and carotid bifurcations were none/minimal in 4 cases, mild in 6 cases, moderate in 6 cases and severe in 2 cases. One patient did not have any neck/chest imaging. The Walrus balloon guide catheter (Q’Apel Medical) was used in most cases. A Neuron Max (Penumbra) and Benchmark catheter (Penumbra) were used in one case each. Use of the 5F Neuron Select SIM-shape catheter was at the discretion of the treating neurointerventionalist. The catheter was formed using the forward push-and-twist technique in all cases and was always advanced over a 0.035-inch Terumo Glidewire. The target vessel was successfully accessed, and the guide catheter successfully delivered in all cases. Mean time from puncture to 1^st target vessel image were 7 minutes. No catheter related vessel injury occurred. Postprocedural MRI imaging was available in 9 patients. Only patient showed a single non-target embolic stroke.

Conclusion Use of a 5F reverse curve insert catheter in emergent stroke interventions is feasible and safe with acceptable occurrence of non-target embolic strokes in a variety of vascular anatomies.

Disclosures A. Kuhn: None. A. Puri: 1; C; NIH, Microvention, Cerenovus, Medtronic Neurovascular and Stryker Neurovascular. 2; C; Medtronic Neurovascular, Stryker NeurovascularBalt, Q’Apel Medical, Cerenovus, Microvention, Imperative Care, Agile, Merit, CereVasc and Arsenal Medical. 4; C; InNeuroCo, Agile, Perfuze, Galaxy and NTI.. S. Sarid: None. M. Garcia: None. J. Singh: None.