Optimal Guiding Catheter Length for Endovascular Coiling of Intracranial Aneurysms in Anterior Circulation in Era of Flourishing Distal Access System / 신경중재치료의학

PURPOSE: To determine the minimum required guiding catheter length for embolization of various intracranial aneurysms in anterior circulation and to analyze the effect of various patient factors on the required catheter length and potential interaction with its stability. MATERIALS AND METHODS: From December 2016 to March 2017, 90 patients with 93 anterior circulation aneurysms were enrolled. Three types of guiding catheters (Envoy, Envoy DA, and Envoy DA XB; Codman Neurovascular, Raynham, MA, USA) were used. We measured the in-the-body length of the catheter and checked the catheter tip location in the carotid artery. We analyzed factors affecting the in-the-body length and stability of the guiding catheter system. RESULTS: The average (±standard deviation) in-the-body length of the catheter was 84.2±5.9 cm. The length was significantly longer in men (89.1±5.6 vs. 82.1±4.6 cm, P<0.001), patients older than 65 years (87.7±7.8 vs. 82.7±4.2 cm, P<0.001), patients with a more tortuous arch (arch type 2 and 3) (87.5±7.4 vs. 82.7±4.4 cm, P<0.001), and patients with a distal aneurysm location (distal group) (86.2±5.0 vs. 82.7±6.1 cm, P=0.004). A shift in the tip location was noted in 19 patients (20.4%); there was no significant different among the 3 catheters (P=0.942). CONCLUSION: The minimum required length of a guiding catheter was 84 cm on average for elective anterior-circulation aneurysm embolization. The length increased in men older than 65 years with a more tortuous arch. We could reach a higher position with distal access catheters with little difference in the stability once we reached the target location.

Forced Arterial Suction Thrombectomy Using Distal Access Catheter in Acute Ischemic Stroke / 신경중재치료의학

Historical innovations in mechanical thrombectomy devices and strategies for ischemic stroke have resulted in improved angiographic outcomes and better clinical outcomes. Various devices have been used, but the two most common approaches are aspiration thrombectomy and stent-retrieval thrombectomy. Aspiration thrombectomy has advanced from the traditional Penumbra system to forced arterial suction thrombectomy and a direct aspiration first-pass technique. Newer generation aspiration catheters with flexible distal tips and a larger bore have demonstrated faster and better recanalization relative to older devices. Recently, several species of distal access catheters have similar structural characteristics to the Penumbra reperfusion catheter. Therefore, we used the distal access catheter for forced arterial suction thrombectomy in three patients with acute ischemic stroke. In each case, we achieved fast and complete recanalization without significant complications. Forced arterial suction thrombectomy using a distal access catheter might provide another option for mechanical thrombectomy in patients with acute ischemic stroke.