Abstract 138: Use of a 046” Intermediate Guide Catheter for Mini‐Triaxial Access in Flow Diversion: Multi‐institution Experience

Abstract

Introduction The latest FDA‐approved intermediate guide catheter, Vecta46, allows for a unique, mini‐triaxial access platform. The size of this catheter allows for 058” guide compatibility, intraluminal accommodation of an 027” microcatheter for flow diverter delivery, and angiographic procedural injections in an 070” guide catheter. Methods We retrospectively identified and analyzed patients who underwent Surpass Evolve flow diversion treatment utilizing the Vecta46 across the senior authors’ institutions. Results The use of the Vecta46 was identified for treatment of 9 aneurysms treated with the Surpass Evolve Flow Diverter (March to April 2023), in patient’s aged 61±3.5 years (range 40‐74 years) with 89% (n=8) female. Aneurysm average size of 4.3±0.47mm, aneurysms originating along the internal carotid artery (n=6) and MCA branches (n=4). Preoperative PRU measured 92 ± 21. Radial access was utilized in 2 cases. Mean Surpass Evolve utilized was 4.4±0.17mm (diameter) by 15.7±0.88mm (length). An 071” guide catheter (Armadillo, Q’Appel Medical) was used in 8 cases. Vecta46 was safely navigated to the supraclinoid ICA segment in all cases. Average fluoroscopy time was 24±3.1 minutes, radiation exposure was 756±259mGy, and verapamil was used in all cases. Technical success was achieved in all cases with adequate vessel wall apposition verified. There were no hemorrhagic complications nor parent vessel wall dissection or vasospasm in the region of the Vecta46 catheter on final control angiography in all 9 cases. Conclusion The new low‐profile Vecta46 intermediate catheter can be safely and effectively utilized in a 6‐French mini‐triaxial system for flow diverter delivery without compromising injection quality, support, or trackability.