Utilization of the Ballast Long Guiding Sheath for Neuroendovascular Procedures: Institutional Experience in 68 Cases.

Ameer E Hassan,Marlon Monayao,Elizabeth M Burke,Wondwossen G Tekle

doi:10.3389/fneur.2021.578446

Abstract

Background: The rise of neurointerventional devices has created a demand for guide systems capable of navigating to the carotid artery consistently regardless of tortuosity. The shift toward large distal access catheters (DACs) and desire for greater trackability have inspired the creation of flexible, supportive, large-lumen long guiding sheaths. Recently, the Ballast long guiding sheath was introduced to provide stability and flexibility while navigating neurointerventional devices through tortuous intracranial anatomy.Objective: To report our experience using the Ballast long guiding sheath in a series of patients undergoing a variety of neuroendovascular procedures.Methods: We retrospectively identified all patients who underwent neuroendovascular treatment with a long guiding sheath were selected from a prospectively maintained endovascular database from January 2019 to November 2019. Baseline clinical characteristics and procedural details were collected.Results: A total of 68 patients were included, mean patient age 67.6 ± 13.6 years. Of the patients treated, 52.9% (36/68) presented with stenosis, 25% (17/68) with aneurysms, 13.2% (9/68) with stroke or emboli, 1.5% (1/68) with a tumor, 1.5% (1/68) with an arteriovenous fistula (AVF), and 4.4% (3/68) with a carotid web. Of the patients with stenosis, 20/36 (55.6%) were extracranial, and 16/36 (44.4%) were intracranial. The Ballast long guiding sheath was used to deliver treatment devices for stenting (37/68, 54.4%), flow diversion (12/68, 17.6%), mechanical thrombectomy (8/68, 11.8%), endovascular coiling (5/68, 7.4%), liquid embolization (3/68, 4.4%), balloon angioplasty (2/68, 2.9%), and balloon angioplasty with stenting (1/68, 1.5%). No Ballast-related complications or adverse events were encountered.Conclusions: We demonstrate the feasibility of the Ballast long guiding sheath to successfully deliver modern neurointerventional treatment devices through tortuous anatomy.

Highlights

We demonstrate the feasibility of the Ballast long guiding sheath to successfully deliver modern neurointerventional treatment devices through tortuous anatomy
As neuroendovascular intervention expands to new applications, and especially as the devices used—from large-bore distal access catheters (DACs) [1] to a wide range of flow diverters [2, 3]—expand in both size and variety, it is increasingly important for long guiding sheaths to be useable through multiple access options, for a range of procedures, across lesion locations
While transfemoral access has been the preferred approach during neurointerventional procedures for decades [6], recent studies have shown the promise of transradial access for the diagnosis and treatment of various cerebral pathologies with embolization, mechanical thrombectomy, microsurgical aneurysm clipping, stenting, and balloon occlusion tests [7,8,9]

Summary

Introduction

As neuroendovascular intervention expands to new applications, and especially as the devices used—from large-bore distal access catheters (DACs) [1] to a wide range of flow diverters [2, 3]—expand in both size and variety, it is increasingly important for long guiding sheaths to be useable through multiple access options, for a range of procedures, across lesion locations. Long guiding sheaths are designed to provide stability while advancing neurointerventional devices across the aortic arch and distal flexibility for advancement in the carotid artery, but analysis concerning the performance of guide technologies is generally published only as subsidiary information to patient outcomes from the treatment device [10]. The shift toward large distal access catheters (DACs) and desire for greater trackability have inspired the creation of flexible, supportive, large-lumen long guiding sheaths. The Ballast long guiding sheath was introduced to provide stability and flexibility while navigating neurointerventional devices through tortuous intracranial anatomy

Methods

Results

Conclusion