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Abstract
Background Successful neuroendovascular treatments rely on microcatheter stability from guide catheter support. We present our experience using a new large-bore, 0.058″ or 0.072″ inner diameter (ID), hyperflexible access catheter placed deep within the intracranial circulation during neurointervention.
Methods We retrospectively reviewed all neurointerventions performed by the senior author during an 18-month period to identify patients in whom the Navien intracranial catheter was placed in an ultra-distal position beyond the clinoidal internal carotid artery (ICA) or the V3 segment of the vertebral artery. Procedural data collected include parent artery tortuosity, technique for Navien advancement, final intra-procedural Navien position, and peri-procedural complications.
Results The Navien, either 6F 0.072” ID or 5F 0.058” ID, provided ultra-distal large-bore access in the following 11 intracranial interventions: anterior circulation aneurysm treatment with Pipeline embolisation device (PED), n=3; posterior circulation aneurysm single-stage stent-coiling, n=5; liquid embolisation of arteriovenous malformations, n=2; PED-coiling of posterior circulation aneurysm, n=1. Table 1 summarises the procedural data for these cases. The Navien was tracked into position over a Marksman microcatheter in 10/11 cases and a Headway 27 microcatheter in one case. Intra-procedural Navien positions were as follows: supraclinoid ICA, n=2; mid M1, n=1; V3–4 junction, n=2 (both using 6F Navien); distal V4, n=3; proximal basilar, n=1; proximal-mid basilar, n=1; mid basilar, n=1. No significant catheter-related complications occurred.
Conclusion The Navien catheter is the newest hyperflexible access catheter that is highly trackable into ultra distal intracranial positions. It manoeuvers atraumatically to provide improved distal intracranial support for a variety of complex cerebrovascular interventions and preserves necessary ID for quality intra-procedural roadmaps/angiography.
Disclosures L. Lin: None. G. Colby: None. J. Huang: None. R. Tamargo: None. A. Coon: 1; C; Stryker for SURPASS Trial and MicroVention for FRED Trial. 2; C; Covidien. 6; C; Pipeline Proctor.