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Introduction
Successful endovascular treatment of intracranial aneurysms and other vascular pathologies of the brain rely on coaxial catheter support systems to provide safe stable access to the intracranial circulation. In general, increased guide catheter support is required for procedures with larger device delivery systems, tortuous anatomy and distal targets. Classic guide catheters are large in size and rigid in design, and these catheters are generally limited in position to the cervical internal carotid artery (ICA). Technological advances have led to a newer generation of distal guide and access catheters that have more supple distal ends, thereby allowing the catheter to navigate further into the intracranial circulation. Previous reports have demonstrated the effectiveness of the Neuron 1-5 and the Outreach distal access catheter (DAC) 6-8 for a variety of neurointerventional procedures.
The introduction and now widespread use of flow diverting devices, including the Pipeline embolization device (PED; Covidien Vascular Therapies, Mansfield, Massachusetts, USA), for the treatment of intracranial aneurysms has resulted in a need for more robust access platforms. This is secondary to the comparatively larger size of the Pipeline delivery catheter (0.027 inch inner diameter (ID)) and the significant intradeployment manipulations required for proper device implantation. As such, there has been a paradigm shift in the design and approach to catheter support systems for cases of Pipeline embolization from a classic biaxial set-up to a more robust triaxial system. 9 Distal intracranial catheters now serve as the cornerstone of these triaxial set-ups.
The Navien 5 Fr, 0.058 inch ID catheter (formerly the ReFlex Intracranial Catheter; Covidien Vascular Therapies, Mansfield, Massachusetts, USA) is a newer generation distal intracranial catheter that is highly trackable and atraumatic with a large-bore lumen that can accommodate 0.027 inch ID delivery catheters with added room for flush and injections. In this report we summarize our experience using the Navien catheter in 78 cases of Pipeline embolization of anterior circulation aneurysms. To our knowledge, this is the first such report on the systematic utilization of the Navien catheter for intracranial procedures, particularly with respect to aneurysm treatment with flow diverters.
Methods
Patient selection
We retrospectively reviewed the records of a prospectively collected single-center aneurysm database to identify all cases in which the Navien catheter was used during Pipeline embolization of an...