E-015 does the choice of intermediate catheter matter?

Abstract

Background Intermediate catheters are increasingly used in neuroendovascular procedures to provide increased stability while trying to obtain distal access or negotiating complicated proximal vascular anatomy. It is currently unclear if any one of these catheters is consistently safer or more efficient than the others. Herein, we report the results of a retrospective study comparing the efficacy and safety of different intermediate catheters that are currently available. Methods We did a retrospective review of our prospectively maintained endovascular procedure database to identify those intracranial trans-arterial neurointerventional procedures in the period between March 2012 and March 2015 where an intermediate catheter was used as part of the procedure. In addition to noting the type of intermediate catheter used in each procedure, data was also gathered on patient demographics, type of anesthesia used, type of procedure and lesion of interest, anatomy of internal carotid artery if applicable, type of intermediate and microcatheter used, distal most location of microcatheter tip, incidence of intermediate catheter failure, intermediate catheter associated spasm and procedural complications if any. A multivariate statistical analysis of variance was then performed to identify if there was a difference in the safety and efficacy of the performance of different intermediate catheters when confounding variables such as choices of microcatheter and arterial anatomy are accounted for. Results We found 136 instances of intermediate catheter use in 115 discrete procedures on 85 patients. There were 53 Navien 058, 33 DAC 044, 28 DAC 038, and 30 Sofia catheters used. There were 21 instances when the intermediate catheter failed to provide adequate distal support to the microcatheter, failed to navigate tortuous proximal anatomy or caused severe vasospasm, these were documented as instances of intermediate catheter failure. Such failure was noted in 8 instances (28%) with DAC 038, 4 instances (12%) with DAC 044, 78 instances (13%) with Navien 058 and 0 instances (0%) with the Sofia catheter (p Conclusion A comparison of the performance of intermediate catheters during intracranial Neurointerventional procedures reveals a wide range in their efficacy and safety making thoughtful intermediate catheter selection a significant consideration. Disclosures D. Sandhu: None. C. Vasquez: None. H. Zacharatos: None. A. Grande: None. R. Tummala: None. B. Jagadeesan: None.