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

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)29-34
Number of pages6
JournalInterdisciplinary Neurosurgery: Advanced Techniques and Case Management
Volume6
DOIs
StatePublished - Dec 1 2016

Keywords

  • Aneurysm
  • Distal access
  • Endovascular
  • Flow diversion
  • Guide catheter
  • Navien
  • Pipeline embolization device
  • Surpass
  • WEB

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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