Distal Microcatheter Placement Using the ASAHI CHIKAI 008 Microguidewire for Liquid Embolic Material Delivery

Abstract

Management of vascular malformations requires microcatheter manipulation through distal tortuous arterial feeders <1 mm in diameter to permit safe and effective embolization at the fistula or nidus location. The ASAHI CHIKAI 008 microguidewire (ACM) recently introduced in the United States was used to evaluate microcatheter torque, support, and safety in distal microcatheter navigation. The use of the ACM in conjunction with flow-directed and over-the-wire microcatheters was evaluated in 25 neuroendovascular cases performed by a single operator for endovascular microcatheter embolization of intracranial vascular malformations over a 1-year period. The study evaluated angiographic evidence of distal microcatheter positioning, subsequent obliteration of the fistula at the location, and any complications. The microguidewire was used in microcatheter embolization of 10 vein of Galen malformations, 11 brain and head and neck arteriovenous malformations, 2 spinal dural arteriovenous fistulas, and 2 cranial dural arteriovenous fistulas. Good flow-directed and over-the-wire microcatheter placement using the ACM was possible across the spectrum of cases achieving optimal catheterization and safe embolization in all. There were no microguidewire- or microcatheter-related vessel spasms, dissections, or perforations during combined or individual manipulation and no contrast or embolic extravasation on fluoroscopy or postembolization angiography. The ACM is a safe, sturdy microguidewire that provides good torque in distal arterial anatomy, while providing microcatheter support and maintaining tip configuration on repeated use.