Pentaxial access platform for ultra-distal intracranial delivery of a large-bore hyperflexible DIC (distal intracranial catheter): A technical note

Li-Mei Lin; Geoffrey P. Colby; Rajiv R. Iyer; Bowen Jiang; Judy Huang; Rafael J. Tamargo; Alexander L. Coon

doi:10.1016/j.inat.2016.06.002

Interdisciplinary Neurosurgery (Dec 2016)

Pentaxial access platform for ultra-distal intracranial delivery of a large-bore hyperflexible DIC (distal intracranial catheter): A technical note

Li-Mei Lin,
Geoffrey P. Colby,
Rajiv R. Iyer,
Bowen Jiang,
Judy Huang,
Rafael J. Tamargo,
Alexander L. Coon

Affiliations

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, CA 92868, United States
Geoffrey P. Colby: Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Zayed 6115C, Baltimore, MD 21287, United States
Rajiv R. Iyer: Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Zayed 6115E, Baltimore, MD 21287, United States
Bowen Jiang: Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Zayed 6115E, Baltimore, MD 21287, United States
Judy Huang: Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Zayed 6115F, Baltimore, MD 21287, United States
Rafael J. Tamargo: Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Zayed 6115G, Baltimore, MD 21287, United States
Alexander L. Coon: Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Zayed 6115E, Baltimore, MD 21287, United States

DOI: https://doi.org/10.1016/j.inat.2016.06.002
Journal volume & issue: Vol. 6, no. C
pp. 29 – 34

Abstract

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Background: Intracranial access techniques in modern neurointervention are shifting towards more robust access platforms. We present in this report a novel method of navigating a 5 French distal intracranial catheter (DIC) deep within the intracranial circulation in an atraumatic fashion via a pentaxial access system. Methods: We retrospectively reviewed all neurointerventions performed at two author institutions identifying all aneurysm treatments where the pentaxial system was used to build the catheter support for intracranial positioning of a 5 French DIC. Procedural data collected include parent artery tortuosity, use of vasodilator, intra-procedural DIC position, and peri-procedural complications. Results: The pentaxial access platform provided ultra-distal intracranial navigation of the 5 French DIC in the following 11 neurointerventions for treatment of anterior circulation aneurysms: Pipeline embolization device (PED) for anterior communicating artery (ACom) aneurysm, n = 2; surpass for large internal carotid artery (ICA) aneurysm, n = 4; Woven EndoBridge (WEB) device for ACom aneurysm, n = 5. Mean patient age was 55 ± 11 years (range 40–75 years). Mean aneurysm size was 6.7 mm ± 3.8 mm (range 2–16 mm). Mean fluoroscopy time was 29 ± 16.7 min. Intra-procedural DIC positions achieved included supraclinoid ICA (n = 6), M1 (n = 4), and A1 (n = 1). No significant catheter-related complications occurred. Conclusion: Distal intracranial catheters can achieve ultra-distal intracranial positions safely with the pentaxial access platform. This technique is a near no step-off, atraumatic method of navigating a DIC in a stepwise fashion over de-escalating smaller diameter catheters via a microwire. Familiarity with catheter specifications including diameters and length is essential for the success of this system.

Published in Interdisciplinary Neurosurgery

ISSN: 2214-7519 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Surgery; Medicine: Internal medicine: Neurosciences. Biological psychiatry. Neuropsychiatry: Neurology. Diseases of the nervous system
Website: http://www.journals.elsevier.com/interdisciplinary-neurosurgery/

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