Utilization of a Novel, Multi-Durometer Intracranial Distal Access Catheter: Nuances and Experience in 110 Consecutive Cases of Aneurysm Flow Diversion

Background: Coaxial catheter support systems provide a safe and stable foundation in endovascular treatment of intracranial aneurysms. Increasingly, robust distal intracranial support is sought during complex neurointerventions. The AXS Catalyst 5 distal access catheter (Cat5) is a new intracranial catheter designed for improved trackability and stability. We report the first experience using Cat5 for aneurysm treatment by flow diversion. Methods: A single-center aneurysm database was reviewed for cases of aneurysm treatment with the Pipeline embolization device (PED) that utilized Cat5. Data were collected for patient demographics, aneurysm characteristics, procedural details, catheter positions, vessel tortuosity, and catheter related complications. Results: One hundred and ten cases of aneurysm flow diversion were successfully performed using Cat5. Patient age ranged from 21 to 86 years (mean 57 ± 12.5 years) with 84% women. Aneurysm size ranged from 2 to 28 mm (mean 5.7 ± 5.0 mm), with 97% in the anterior circulation. Twenty-four aneurysms (22%) were located beyond the ICA termination. Significant cervical carotid tortuosity was present in 26% of cases, and moderate to severe cavernous tortuosity (cavernous grade ≥2) in 45% of cases. Cat5 was tracked to the intended distal position in all cases with 100% technical success of PED implantation. No iatrogenic catheter-related vessel injury occurred, and major neurological morbidity occurred in 1 patient (1%). Summary: The Cat5 is a novel, multi-durometer cranial distal access catheter designed for use in tri-axial systems. We have demonstrated the utility of Cat5 in 110 successful cases of flow diversion with a wide range of complexity. This catheter is a new tool in the neurointerventionalist's armamentarium to achieve robust and atraumatic distal access.

Triple Coaxial Catheter Technique for Transfacial Superior Ophthalmic Vein Approach for Embolization of Dural Carotid-Cavernous Fistula

We report a triple coaxial catheter technique to facilitate the venous access to the superior ophthalmic vein during transvenous embolization of dural carotid-cavernous fistula (DCCF) via the transfacial venous route. Two patients with transvenous embolization of DCCFs by coils were treated with transfacial superior ophthalmic vein (SOV) approach by the triple coaxial catheter technique. The triple coaxial catheter system consisted of a 6F guiding catheter as the outer catheter and a 4F guiding catheter as the middle catheter and a microcatheter as the inner catheter to help navigation and manipulation. The DCCFs were completely obliterated in both cases. There were no complications associated with the procedure. The ophthalmic symptoms of the patients had totally resolved at two-month follow-up. The triple coaxial catheter technique can be used with the transfacial SOV approach in embolization of DCCF. This technique has two advantages over the double coaxial catheter technique because it offers additional length and support for the distal navigation of microcatheter into the SOV.