Ultra-distal large-bore intracranial access using the hyperflexible Navien distal intracranial catheter for the treatment of cerebrovascular pathologies: a technical note
Ultra-distal large-bore intracranial access using the hyperflexible Navien distal intracranial catheter for the treatment of cerebrovascular pathologies: a technical note
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DOI：
10.1136/neurintsurg-2013-010772
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发表时间：
2014-05-01
影响因子：
4.8
通讯作者：
Coon, Alexander L.
中科院分区：
文献类型：
--
作者：
Lin, Li-Mei;Colby, Geoffrey P.;Coon, Alexander L.
背景成功的神经血管内治疗依赖于来自导引导管支持的微导管稳定性。我们介绍了我们的经验，使用一种新的大口径0.058英寸或0.072英寸内径（ID）超柔性接入导管放置在颅内循环深处在neuropintervention.MethodsWe回顾性审查了所有神经介入的资深作者在18个月期间，以确定患者的Navien颅内导管放置在超远端位置，定义为超出床突颈内动脉（伊卡）或椎动脉的V3段。收集的手术数据包括载瘤动脉迂曲度，Navien推进技术，术中Navien位置和围手术期并发症。结果Navien，无论是6 F 0.072英寸ID或5 F 0.058英寸ID，在以下11项颅内介入治疗中提供了超远端大口径入路：前循环动脉瘤治疗与Pipeline栓塞装置（PED）（n=3）;后循环动脉瘤一期支架弹簧圈栓塞术（n=5）;动静脉畸形液体栓塞术（n=2）;后循环动脉瘤PED弹簧圈栓塞术（n=1）。在10/11例病例中，Navien在Marksman微导管上跟踪到位，在1例病例中，Navien在Headway 27微导管上跟踪到位。术中Navien位置如下：ICA床伊卡（n=2）; M1中段（n=1）; V3-V4交界处（n=2）（均使用6 F Navien）; V4远端（n=3）;基底动脉近端（n=1）;基底动脉近端-中段（n = 1）;基底动脉中段（n=1）。没有显着的导管相关并发症occurrence.ConclusionsThe Navien是最新的超柔性通路导管，是高度可跟踪到超远端颅内位置。它可无创伤地进行操作，为各种复杂的脑血管介入手术提供更好的远端颅内支持，并为高质量的术中路线图和血管造影保留必要的ID。
BackgroundSuccessful neuroendovascular treatments rely on microcatheter stability from guide catheter support. We present our experience using a new large-bore 0.058 inch or 0.072 inch inner diameter (ID) hyperflexible access catheter placed deep within the intracranial circulation during the neurointervention.MethodsWe 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, defined as beyond the clinoidal internal carotid artery (ICA) or V3 segment of the vertebral artery. Procedural data collected included parent artery tortuosity, technique for Navien advancement, intraprocedural Navien position and periprocedural complications.ResultsThe Navien, either 6 F 0.072 inch ID or 5 F 0.058 inch ID, provided ultra-distal large-bore access in the following 11 intracranial interventions: anterior circulation aneurysm treatment with Pipeline embolization device (PED) (n=3); posterior circulation aneurysm single-stage stent coiling (n=5); liquid embolization of arteriovenous malformations (n=2); PED coiling of posterior circulation aneurysm (n=1). The Navien was tracked into position over a Marksman microcatheter in 10/11 cases and a Headway 27 microcatheter in one case. Intraprocedural Navien positions were as follows: supraclinoid ICA (n=2); mid M1 (n=1); V3-V4 junction (n=2) (both using 6 F Navien); distal V4 (n=3); proximal basilar (n=1); proximal-mid basilar (n=1); mid basilar (n=1). No significant catheter-related complications occurred.ConclusionsThe Navien is the newest hyperflexible access catheter that is highly trackable into ultra-distal intracranial positions. It maneuvers atraumatically, providing improved distal intracranial support for a variety of complex cerebrovascular interventions and preserves necessary ID for quality intraprocedural roadmaps and angiography.