Steerable Microcatheter Research Articles

Steerable microcatheter to negotiate a hairpin angle during primary percutaneous coronary intervention.

Steerable microcatheter to negotiate a hairpin angle during primary percutaneous coronary intervention.

3-Fr steerable microcatheter system via the upper limb artery in RADPLAT for right maxillary cancer

Background To evaluate the efficacy of a catheter system using a 3-Fr sheath with a steerable microcatheter through right upper limb artery access for superselective intra-arterial cisplatin infusion and concomitant radiotherapy (RADPLAT) to treat right maxillary sinus squamous cell carcinoma (MS-SCC). Material and methods We retrospectively studied 46 sessions in eight patients treated between November 2020 and February 2023 using the catheter system briefly described below. A 3-Fr sheath was inserted into the distal radial, conventional radial, or brachial arteries. A coaxial catheter system with a 2.9-Fr steerable microcatheter and a 1.9-Fr microcatheter was advanced into the brachiocephalic artery. The right common carotid artery was selected by bending the tip of the steerable microcatheter. Coil embolization and intra-arterial cisplatin infusion after selecting each external carotid artery branch were achieved using this catheter system. Results Cisplatin infusion and coil embolization were successful in all sessions. Arterial occlusion at the sheath insertion sites was found in 29.4% (5/17) of the distal radial arteries and 33.3% (3/9) of the conventional radial arteries. No other major complications were observed during the procedure. Conclusion Using a 3-Fr catheter system with a steerable microcatheter through right upper limb artery access is a feasible method for RADPLAT in treating right MS-SCC.

Novel Uses of the SwiftNinja Steerable Microcatheter for Pediatric Cardiovascular Interventions.

In the present era, the intricacy of procedures undertaken by a pediatric interventional cardiologist has increased, primarily attributed to dealing with smaller, younger patients with more complex anatomies. To adapt to these smaller and more complex patients, we must adapt our interventions and our equipment to perform these procedures. This article outlines various innovative applications of the SwiftNinja steerable microcatheter within the pediatric cardiac catheterization laboratory.

The Utility of the "LEONIS Mova" Steering Microcatheter in Flow Diverter Placement.

LEONIS Mova (SB-KAWASUMI LABORATORIES, Kanagawa, Japan, hereinafter called LEONIS Mova) is a steerable microcatheter (MC) that enables angle adjustment of the catheter tip using a hand-operated dial. LEONIS Mova may be useful for flow diverter placement when access to the distal parent artery with a conventional MC and microguidewire (MGW) is considered difficult or impossible. Here, we report three such cases encountered during flow diverter placement in large and giant internal carotid artery aneurysms. In Case 1, a strong S-shaped curve was observed in the proximal parent artery of a giant cerebral aneurysm, and the luminal structure of the parent artery was lost within the aneurysm. It was anticipated that the distal side of the parent artery would be difficult to access with conventional MC and MGW. By adjusting the tip of the LEONIS Mova toward the aneurysm outlet beyond the S-shaped curve, it was possible to induce the MGW to secure the distal parent artery easily. In Case 2, the inflow and outflow axes of the parent artery were completely misaligned at the site of the aneurysm, and stenosis was present in the distal parent artery. Firmly bending the catheter tip increased accommodation for the catheter, enabling the induction of an MGW to access the distal parent artery without kicking back. In Case 3, the lesion extended from the cavernous portion to the petrosal portion; however, by adjusting the tip of the LEONIS Mova toward the aneurysm outlet, it was possible to induce the MGW to secure the distal parent artery easily. In each case, the LEONIS Mova enabled more secure and prompt access to the parent artery than anticipated and facilitated flow diverter placement. Encountering difficult-to-access lesions is one reason endovascular treatment may be unsuccessful. The LEONIS Mova is an excellent device that can overcome this obstacle, and its utility in certain applications should be recognized.

A Steerable Microcatheter Effectively Worked in Tumor Embolization

A Steerable Microcatheter Effectively Worked in Tumor Embolization

SwiftNINJA steerable microcatheter: a new kid on the block for selective catheterization of vascular and valvular congenital lesions.

SwiftNINJA (Merit Medical Systems, USA) is a novel steerable microcatheter intended for coronary and peripheral vascular interventions. We evaluate and report the first use of SwiftNINJA in pediatric catheterization of congenital heart defects (CHDs). We performed a retrospective clinical data review of children with CHDs in whom SwiftNINJA was used during cardiac catheterization between April 2022 and June 2023. Utility, application, and standard safety were described comprehensively. We identified 19 patients (78.9% males) with a median age of 5.3 months (IQR, 2-13.9), and a median weight of 5.3 kg (IQR, 4-7.7). 36.8% of the catheterizations were transarterial and 78.9% were interventional. SwiftNINJA was applied upfront in 3/19 patients to cannulate precisely the right pulmonary artery and eliminate the risk of dislocating a freshly implanted left pulmonary flow restrictor. In 16/19 patients, SwiftNINJA was applied after a median of 5 (IQR, 5-7) failed catheterization attempts using various combinations of catheters, microcatheters, and wires to cannulate challenging vasculature in seven, engage the lumen of stented vessels in five, cross complex aortic valve stenosis in three, and cross an apical ventricular septal defect in one patient with Damus-Kaye-Stansel repair. After the SwiftNINJA application, catheterization was done from the first attempt in 12/16 patients and from the second attempt in 4/16 patients. The median applied tip angulation was 90 degrees (IQR, 85-95). All procedures were completed successfully. No device malfunction or adverse events occurred. SwiftNINJA is a valuable addition for selective catheterization of challenging vasculatures or valvular anatomies in children with CHDs.

Successful coil embolisation of tortuous portosystemic venous shunts using a steerable microcatheter in a patient with polysplenia after a Fontan-type operation.

Portosystemic venous shunts occur in patients with polysplenia after the Fontan operation. In the long term, these shunts are associated with hyperammonaemia and portal-systemic encephalopathy. Since some shunts are long and tortuous, catheter interventions to close them could be challenging. Instead, a steerable microcatheter could be used for coil embolisation of tortuous portosystemic venous shunts.

Position and Orientation Control of Multisection Magnetic Soft Microcatheters

Soft continuum robots (CRs) can be potentially applied in minimally invasive surgery due to their slender continuously deformable bodies. However, miniaturization, dexterity, and control accuracy remain as targets and challenges for medical soft CRs. In this article, we present a control strategy for a minimalist structured multisection magnetic continuum robot (MCR) to show its dexterous and accurate motion ability. The robot is embedded with two opposite axially polarized magnets. This makes it capable of deforming in a higher order curve under the influence of an external mobile magnet. This minimalist structure is suitable for submillimeter steerable microcatheters, and facilitates micromanipulation in hard-to-access region of the body. Using a Jacobian-based inverse kinematics method, the robot realizes tip position and orientation control, as well as multisection control in three dimensions with the accuracy of up to 1.30 ± 0.48 mm and 2.8 ± 1.0°. Furthermore, we showcase various medical applications of our proposed MCR for dexterous navigation, orthogonal motion, and pivoting motion. Our article aims to demonstrate dexterous and accurate motion capability of the proposed multisection magnetic soft microcatheter, which helps execute significant robotic tasks in real-world clinical applications.

Abstract Number ‐ 178: Optimizing Skin to Device at Occlusion Time Utilizing A Non‐exchange Technique with Novel Steerable Microcatheter

Introduction Vascular tortuosity and difficult access to the target vessel during mechanical thrombectomy is one of the reasons for failed reperfusion. The 021 Bendit adjustable micro catheter is a torqueable microcatheter with an adjustable, 360 rotating, bendable tip. Its unique structure provides it with trackability and support allowing it to be used as a select catheter for the guide and to directly access the target vessel without a guidewire. This feature can result in significant reduction in groin puncture to recanalization time, with possible implications on patient outcomes. It is also designed to fit in a standard sized aspiration catheter and allow delivery of a stentriever device if needed. Herein we describe the first US experience in 021 Bendit adjustable microcatheter in vessel selection and intracranial navigation in patients with large vessel occlusions. Methods We describe our experience with three patients who presented with large vessel occlusions for mechanical thrombectomy in July 2022. The system with guide catheter loaded with aspiration catheter and Bendit adjustable microcatheter was used to directly select the target vessels starting at the arteriotomy site, off the aortic arch and its support was used to advance the guide catheter into the cervical segment. It was then delivered to the intracranial circulation where it was used to deliver the aspiration catheter. Results Patient A is a 73‐year‐old man with a left M1 occlusion. The Bendit microcatheter was advanced through a 071 intermediate catheter and through a 088 guide catheter and was used to select the left common carotid artery. Time between device entering the body to clot touch time of 18 minutes. Patient B is a 57‐year‐old man who presented with a left cavernous internal carotid artery occlusion. The Bendit microcatheter was advanced through a 071 intermediate catheter and a 088 guide catheter was used to successfully select the left common carotid artery.Time between device entering body and bendit being at first lesion is 3 minutes. Patient C is a 60‐year‐old woman with a basilar occlusion. A 088 guide catheter was advanced over 071 intermediate catheter which was advanced over the Bendit microcatheter into the aortic arch. The Bendit microcatheter was maneuvered to select the right subclavian artery and the right vertebral artery, the system was subsequently advanced over the Bendit microcatheter intracranially. Time between groin puncture to aspiration device at the clot was 5 minutes. Conclusions The Bendit steerable microcatheter can be used to maneuver through the aortic arch and successfully select the target vessel without an exchange and without a guidewire. This approach can dramatically reduce access to recanalization time and ultimately neurologic outcomes in patients undergoing mechanical thrombectomy. As more experience is obtained, best practices will be able to achieve consistently lower times.

Utility of a Steerable Microcatheter for the Selective Transvenous Embolization of Dural Arteriovenous Fistulas.

Selective transvenous embolization (sTVE) is an effective technique for treating dural arteriovenous fistulas (DAVFs); however, selective catheterization into the shunted pouch is often difficult due to the acute angle of the access route between the target pouch and dural sinus. We present our initial experience using a steerable microcatheter (SM) to manually control the tip angle for selective catheterization and sTVE of DAVFs. Thirteen consecutive cases of DAVFs and 16 procedures that involved sTVE using SM between October 2016 and October 2018 were reviewed. SMs were used for selective catheterization of shunted venous pouches and/or the affected sinus and coil embolization. We evaluated the maneuverability of the SM, the success of selective catheterization into the target lesions, and the results of endovascular treatments. Endovascular procedures were performed in a single session in 10 cases and in two staged sessions in 3 cases. There was no difficulty in maneuverability of the SM. Successful selective catheterization was achieved in 26 of 27 target lesions. Immediately after embolization, angiography showed complete occlusion in 10 cases and marked reduction in 3 cases. During 40.9 months of mean follow-up, 12 cases showed complete occlusion and one case showed a small residual shunt on MRI. Procedure-related complications of spontaneous thrombosis of the affected sinus were observed in one case. There were no cases of recurrence or exacerbation during follow-up. SM is useful for selective catheterization for target lesions during sTVE of DAVFs.

Clinical experience with the Bendit steerable microcatheter: a new paradigm for endovascular treatment

BackgroundVessel tortuosity poses a challenge during endovascular treatment of neurovascular lesions. Bendit Technologies (Petah Tikva, Israel) has developed flexible, steerable microcatheters designed with unique bending and torquing capabilities.ObjectiveTo describe our...

New concept in neurovascular navigation: technical description and preclinical experience with the Bendit 17 and Bendit 21 microcatheters in a rabbit aneurysm model

BackgroundEndovascular treatment of intracranial vascular diseases, such as aneurysms, is often challenged by unfavorable vascular anatomy. The Bendit Steerable Microcatheter (Bendit Technologies, Tel Aviv, Israel) has bending and torqueing capabilities...

Soft robotic steerable microcatheter for the endovascular treatment of cerebral disorders.

Catheters used for endovascular navigation in interventional procedures lack dexterity at the distal tip. Neurointerventionists, in particular, encounter challenges in up to 25% of aneurysm cases largely due to the inability to steer and navigate the tip of the microcatheters through tortuous vasculature to access aneurysms. We overcome this problem with submillimeter diameter, hydraulically actuated hyperelastic polymer devices at the distal tip of microcatheters to enable active steerability. Controlled by hand, the devices offer complete 3D orientation of the tip. Using saline as a working fluid, we demonstrate guidewire-free navigation, access, and coil deployment in vivo, offering safety, ease of use, and design flexibility absent in other approaches to endovascular intervention. We demonstrate the ability of our device to navigate through vessels and to deliver embolization coils to the cerebral vessels in a live porcine model. This indicates the potential for microhydraulic soft robotics to solve difficult access and treatment problems in endovascular intervention.

Coil-assisted retrograde transvenous obliteration (CARTO) for the treatment of gastric varices via a single access route using steerable microcatheter: a case report

BackgroundCoil-assisted retrograde transvenous obliteration (CARTO) is a modified balloon-occluded retrograde transvenous obliteration (BRTO) technique using coils instead of an indwelling balloon. A method involving two microcatheter systems forming a double access route has been reported. We report a case of CARTO using a steerable microcatheter to successfully treat gastric varices (GV).Case presentationA 79-year-old man was admitted for treatment of intractable GV due to liver cirrhosis. The GV were drained mainly into the left inferior phrenic vein, not the usual gastrorenal shunt. Introducing the balloon catheter to the left inferior phrenic vein was difficult due to mild stenosis between the inferior vena cava and inferior phrenic vein and the shunt angle. A CARTO technique was performed with 5% ethanolamine oleate with iopamidol from a single access route by inverting the steerable microcatheter distal to the coil placement site.ConclusionCARTO has advantages in cases where performing BRTO is difficult. Using a steerable microcatheter simplifies the procedure by reducing the required access routes in CARTO.

Efficacy and safety of guidewireless catheterization with a steerable microcatheter in patients scheduled for yttrium-90 radioembolization: a prospective multicenter trial.

IntroductionA steerable, guidewireless microcatheter is of interest to interventional radiologists because it can improve effectiveness and reduce procedure timing and cost.AimTo assess the feasibility and safety of yttrium 90 radioembolization with a new steerable microcatheter without the need to use a guidewire.Material and methodsA steerable microcatheter (Direxion; Boston Scientific, Natick, MA, USA) was prospectively used for yttrium-90 microsphere delivery in 50 patients (57 applications). The following factors were documented: vessel anatomy; shape and position of the guiding catheter; anticipated catheter position; technical success of catheterization; degree of difficulty in maneuvering; time to reach the target position; and complications.ResultsThe microcatheter target position was in the right hepatic artery (n = 30, 53%), the middle hepatic artery (n = 4, 7%), the left hepatic artery (n = 19, 33%), or in a segmental artery (n = 4, 7%). Vessel catheterization was successful in 53 of 57 hepatic arteries (93%). The mean time to reach the target position was 53.3 ±53.0 s. The mean degree of difficulty in maneuvering the catheter to the target position was 2.3 ±1.3 (easy) on a 6-point scale. The only complication observed was mild vasospasm in 1 patient.ConclusionsThe Direxion steerable microcatheter is characterized by unique steerability, allowing yttrium 90 delivery to be performed safely without use of a guidewire.

Use of a steerable microcatheter during superselective angiography: impact on radiation exposure and procedural efficiency

Background/purposeTo study steerable microcatheter (SM) use in moderate and highly difficult vessel selection compared to conventional pre-shaped microcatheter (CM) use.Material and methodsAn IRB approved, single institution analysis of 40 complex angiographic procedures with and without superselective microcatheter use during an eight-month period in 2017 was performed. Target vessels were deemed moderate or highly difficult to select based on vessel size, tortuosity, and/or angulation during non-selective initial angiography. Data collected included type of microcatheter used (SM or CM), number of microcatheters and microwires used, procedure time, radiation exposure index (dose area product/DAP), target vessel location, and time to target vessel selection (TTVS; time from device placement to vessel selection). Comparison between the SM and CM groups was performed using Wilcoxon test.ResultsA SM (SwiftNinja, Merit Medical, South Jordan, UT, USA) was used to select 46 vessels in 20 patients. One or more CMs were used in 20 patients to select 34 vessels. Median TTVS, number of microwires used, total procedure time, and DAP (microGray.m2) were 12 vs. 462.5 s (p < 0.0001), 0 vs. 2 (p < 0.001), and 26,948 vs. 30,904 (p = 0.15) in the SM vs. CM groups, respectively. When adjusted for body mass index (BMI) using a linear model for radiation exposure, patients in the SM group had lower radiation exposure than those in the CM group (p = 0.05).ConclusionsUtilization of a steerable microcatheter, without or with a guidewire, leads to easier and faster target vessel selection with shorter procedure times in complex vessel anatomy.

Use of a steerable triaxial system for challenging catheterization

Purpose: A steerable triaxial system consisting of a small microcatheter, a high-flow steerable microcatheter, and a 4-Fr. catheter is currently used in clinical settings. The purpose of the present study was to evaluate the efficacy and safety of the steerable triaxial system for challenging catheterization.Material and methods: Sixteen patients underwent an interventional procedure with the steerable triaxial system. Medical records and images of the procedures were reviewed, and the technical success rate, clinical success rate, and complications related to the procedures were evaluated. Technical success was defined as successful catheterization to the target artery using the steerable triaxial system, and clinical success as completion of the aimed procedure.Results: Catheterization to the target artery was successfully performed with the steerable triaxial system in 14 out of 16 patients, but was unsuccessful in two. Therefore, the technical success rate was 88% (14/16). The procedure was successfully accomplished in the 14 technical success patients. Thus, the clinical success rate was 88% (14/16). There were no complications related to the procedures.Conclusions: The steerable triaxial system has potential as a useful and safe technique for challenging catheterization.

Pediatric Traumas and Paradigm Shifts: The Necessary Adaption of the Steerable Microcatheter in Pediatric Interventional Radiology.

The use of traditionally available intra-arterial devices have historically been designed with the adult patient population in mind. Currently, there are not manufactured devices specifically tailored for use during pediatric interventional procedures, pressuring interventional operators to adapt commonplace and readily available devices for interventional management. Experienced interventional operators understand that pediatric and adult interventions can entail vastly different management, affecting patient care and outcomes. To address the pitfalls in pediatric interventional management, an accredited fellowship specifically for pediatric interventional radiology is available. However, devices must equally evolve with the training available in order to adequately address interventional management of the pediatric patient population. Interventional device innovation can be considered the initial step towards bridging the technical and procedural gaps necessary for refining pediatric intervention. The introduction of steerable microcatheters in interventional radiology has innovated procedural protocols, but has never been documented in pediatric patients until this time.

Time is Brain: The Future for Acute Ischemic Stroke Management is the Utilization of Steerable Microcatheters for Reperfusion.

Stroke is the fifth leading cause of death in the United States and is one of the leading causes of patient disability. Treatments for intracranial intravascular damage as a result of stroke have evolved extensively over recent decades, as management has become increasingly innovative. Various prospective studies and years of data have refined the current guidelines for treatment of acute ischemic stroke (AIS) and also reflect on the novel interventions for stroke management. Nonetheless, AIS remains a difficult and multifactorial etiology of disease to treat. As physicians adapt evidence-based knowledge to their interventional management of patients with AIS, the accompanied use of intravascular devices, such as steerable microcatheters, reduces radiation and procedure time. Considering all of the applications for steerable microcatheters, the use of these devices for AIS interventions may be most necessary.

Against the Odds: A Novel Technique to Perform Cholangiography from a Percutaneous Approach through the Cystic Duct.

Percutaneous cholangiography is typically performed via a transhepatic approach and is reserved for patients with contraindications to traditional cholangiogram imaging modalities. For those with suspected cholelithiasis or choledocholithiasis who cannot undergo magnetic resonance imaging for diagnosis, percutaneous cholecystostomy with cholangiogram is a viable option. Endoscopic retrograde cholangiopancreatography may also be precluded due to anatomic or obstructive limitations, in which case, percutaneous transhepatic cholangiography (PTC) may be indicated for diagnosis. PTC may be difficult in a patient with minimal biliary tree dilatation, or tortuous cystic duct anatomy. In cases such as these, a steerable microcatheter (SMC) may be utilized to enable or expedite PTC. The technique to traverse and catheterize the cystic duct and opacify the gallbladder, bile ducts, and duodenum utilizing an SMC is described. This report outlines a non-vascular application of the SMC resulting in a successful cholangiogram, with reduced operative time and thus reduced radiation exposure to the patient.