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Campos JK, Zarrin DA, Meyer BM, Khan MW, Laghari FJ, Collard de Beaufort JC, Amin G, Beaty NB, Bender MT, Suzuki S, Colby GP, Lin LM, Coon AL. Use of a large-bore 088 intracranial access support catheter for delivery of large intracranial devices: case series with the TracStar LDP in 125 cases. J Neurointerv Surg 2024:jnis-2023-021054. [PMID: 38418227 DOI: 10.1136/jnis-2023-021054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/02/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND The delivery of neuroendovascular devices requires a robust proximal access platform. This demand has previously been met with a 6Fr long sheath (8Fr guide) that is placed in the proximal internal carotid artery (ICA) or vertebral artery segments. We share our experience with the first 0.088 inch 8Fr guide catheter designed for direct intracranial access. METHODS We retrospectively reviewed a prospectively maintained IRB-approved institutional database of the senior authors to identify all cases where the TracStar Large Distal Platform (LDP) was positioned within the intracranial vasculature, defined as within or distal to the petrous ICA, vertebral artery (V3) segments, or transverse sinus. Technical success was defined as safe placement of the TracStar LDP within or distal to the described distal vessel segments with subsequent complication-free device implantation. RESULTS Over the 41-month study period from January 2020 to June 2023, 125 consecutive cases were identified in whom the TracStar LDP was navigated into the intracranial vasculature for triaxial delivery of large devices, 0.027 inch microcatheter and greater, for aneurysm treatment (n=108, 86%), intracranial angioplasty/stenting (n=15, 12%), and venous sinus stenting (n=2, 1.6%). All cases used a direct select catheter technique for initial guide placement (no exchange). Posterior circulation treatments occurred in 14.4% (n=18) of cases. Technical success was achieved in 100% of cases. No vessel dissections occurred in any cases. CONCLUSION The TracStar LDP is an 0.088 inch 8Fr guide catheter that can establish direct intracranial access with an acceptable safety profile. This can be achieved in a wide range of neurointerventional cases with a high rate of technical success.
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Affiliation(s)
- Jessica K Campos
- Department of Neurosurgery, University of California Irvine, Orange, California, USA
| | - David A Zarrin
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Benjamen M Meyer
- College of Medicine Tucson, The University of Arizona, Tucson, Arizona, USA
| | - Muhammad Waqas Khan
- Carondelet Neurological Institute, Carondelet Saint Joseph's Hospital, Tucson, Arizona, USA
| | - Fahad J Laghari
- Carondelet Neurological Institute, Carondelet Saint Joseph's Hospital, Tucson, Arizona, USA
| | | | - Gizal Amin
- Carondelet Neurological Institute, Carondelet Saint Joseph's Hospital, Tucson, Arizona, USA
| | - Narlin B Beaty
- Department of Neurosurgery Tallahassee Memorial Hospital, Tallahassee Memorial Hospital Florida State University, Tallahassee, Florida, USA
| | - Matthew T Bender
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Shuichi Suzuki
- Department of Neurosurgery, University of California Irvine, Orange, California, USA
| | - Geoffrey P Colby
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Li-Mei Lin
- Carondelet Neurological Institute, Carondelet Saint Joseph's Hospital, Tucson, Arizona, USA
| | - Alexander L Coon
- Carondelet Neurological Institute, Carondelet Saint Joseph's Hospital, Tucson, Arizona, USA
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Waters MJ, Vargas J, Turk A, Chaudry I, Turner RD. Safety and feasibility of the Wahoo Hybrid Access System, a dual-mode guide catheter, in a range of neuroendovascular procedures. Interv Neuroradiol 2023:15910199231155033. [PMID: 36751023 DOI: 10.1177/15910199231155033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND There is a clinical need for a guide catheter with combined stability and navigability, which can be used in a biaxial system for neuroendovascular procedures in place of triaxial systems. OBJECTIVE To assess the safety and feasibility of the Q'Apel Medical Wahoo Hybrid Access System, a dual-mode 0.072″ internal diameter guide catheter, in a range of neuroendovascular procedures. METHODS We performed a retrospective analysis of consecutive cases from a high-volume tertiary center in which the Wahoo Hybrid Access System was used as the guide catheter. Characteristics of the patients, vascular lesions, procedure, and procedural complications were assessed. RESULTS A total of 102 patients were included for analysis. Vascular lesions were in the anterior circulation in 90 of 102 (88%), and posterior circulation in 12 of 102 (12%). Eighty-four cases were ruptured or unruptured aneurysm embolization procedures, the majority being balloon-assisted coiling (42%) and flow diversion (42%). All cases, including flow diversion, were performed as a biaxial system. There were no instances of prolapse of the catheter beyond the arterial segment in which it was initially placed. The procedure was able to be performed to completion in 101 of 102 (99%) cases. Thromboembolic complications occurred in 5 of 102 (5%); causality in two cases was unrelated to the guide catheter, and three were indeterminate. CONCLUSIONS The Wahoo guide catheter is safe and feasible when used in a variety of neuroendovascular procedures. It can accommodate a range of devices, can be safely navigated into distal vasculature, and provides support for a range of procedures, including those which traditionally require triaxial support.
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Affiliation(s)
- Michael J Waters
- Department of Neurosurgery and Neuroendovascular Surgery, 3626Prisma Health Upstate, Greenville, SC, USA
| | - Jan Vargas
- Department of Neurosurgery and Neuroendovascular Surgery, 3626Prisma Health Upstate, Greenville, SC, USA
| | - Aquilla Turk
- Department of Neurosurgery and Neuroendovascular Surgery, 3626Prisma Health Upstate, Greenville, SC, USA
| | - Imran Chaudry
- Department of Neurosurgery and Neuroendovascular Surgery, 3626Prisma Health Upstate, Greenville, SC, USA
| | - Raymond D Turner
- Department of Neurosurgery and Neuroendovascular Surgery, 3626Prisma Health Upstate, Greenville, SC, USA
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Bageac DV, Gershon BS, Shigematsu T, Majidi S, De Leacy RA. Early institutional experience using the TracStar Large Distal Platform in endovascular flow diversion. Neuroradiol J 2021; 35:313-318. [PMID: 34473002 DOI: 10.1177/19714009211041520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The delivery of flow-diverting stents (FDS) necessitates a degree of catheter support beyond that required for endovascular coiling. The TracStar Large Distal Platform (LDP) is a novel 0.088″ platform intended for navigation into the intracranial internal carotid artery (ICA). We present an early institutional experience using the TracStar LDP in 44 cases of endovascular aneurysm embolization using FDS. METHODS Inclusion criteria for this single-center retrospective review encompassed all patients >18 years of age who were treated for intracranial aneurysms. Procedural success was defined as successful stent deployment using the TracStar LDP. Other outcomes included periprocedural complications, use of an intermediate catheter, length of stay, and discharge disposition. RESULTS The TracStar LDP was utilized in 44 consecutive FDS cases in 42 patients. Cavernous segment aneurysms constituted the majority of cases (12/42; 28.6%), followed by posterior communicating artery (8/42; 19.0%) and supraclinoid aneurysms (8/42; 19.0%). Successful FDS deployment was achieved in 43/44 cases. The LDP achieved stable positioning within the ascending cavernous ICA in 63.6% of cases. A biaxial system was utilized in 54.5% of cases. There was one complication potentially related to use of the TracStar LDP, which was an asymptomatic ICA vessel dissection managed conservatively. CONCLUSIONS The TracStar LDP is safe and effective during use in the endovascular treatment of intracranial aneurysms with a FDS. Access to the ascending portion of the cavernous ICA was regularly achieved, and the platform allowed for both biaxial and triaxial configurations.
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