47 Consecutive Cases of Pipeline Flex Flow Diversion Utilizing a Novel Large-Bore Intracranial Intermediate Catheter: Nuances and Institutional Experience with the Syphontrak

Lin, Li-Mei; Jiang, Bowen; Bender, Matthew T.; Westbroek, Erick M.; Campos, Jessica K.; Tamargo, Rafael J.; Huang, Judy; Coon, Alexander L.; Colby, Geoffrey P.

doi:10.1159/000486538

Cited by 11 publications

(4 citation statements)

References 16 publications

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“…In recent years, a number of similar case series have reported results using intermediate catheters during FDS cases to build triaxial systems that maximize support during stent deployment. [13][14][15] Direct comparison with these previous experiences is complicated by the fact that advancement of the TracStar LDP was not required or attempted in all cases. However, the high rate of cavernous access and low complication rate in this series should draw attention to the question as to whether distal 0.088 00 access can provide efficient alternative distal access catheter usage in select cases.…”

Section: Discussionmentioning

confidence: 99%

Early institutional experience using the TracStar Large Distal Platform in endovascular flow diversion

et al. 2021

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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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Section: Discussionmentioning

confidence: 99%

Early institutional experience using the TracStar Large Distal Platform in endovascular flow diversion

et al. 2021

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“…When used in conjunction with long guiding sheaths, such as the Ballast, these DACs can provide the proximal support needed while simultaneously maintaining flexibility for improved navigation. This system allows for the delivery of a wide range of therapeutic devices through a larger ID, which is crucial for large modern neuroendovascular devices, such as flow diverters (15,21).…”

Section: Discussionmentioning

confidence: 99%

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

2021

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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.

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“…The delivery of neuroendovascular devices requires a catheter access platform which features robust proximal and distal support, and trackability through tortuous vasculature. [1][2][3][4] These requirements have been commonly met by the use of a triaxial system consisting of a guide catheter, intermediate catheter, and a microcatheter system. 5 6 An 0.088 inch (8Fr) guide catheter is often used in these set-ups to provide proximal support while traversing the aortic arch and large proximal vessels, with smaller diameter intermediate catheters used to provide distal support closer to the site of intervention.…”

Section: Introductionmentioning

confidence: 99%

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

Campos,

Zarrin,

Meyer

et al. 2024

J NeuroIntervent Surg

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BackgroundThe 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.MethodsWe 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.ResultsOver 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.ConclusionThe 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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47 Consecutive Cases of Pipeline Flex Flow Diversion Utilizing a Novel Large-Bore Intracranial Intermediate Catheter: Nuances and Institutional Experience with the Syphontrak

Cited by 11 publications

References 16 publications

Early institutional experience using the TracStar Large Distal Platform in endovascular flow diversion

Early institutional experience using the TracStar Large Distal Platform in endovascular flow diversion

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

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

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