Distal access using hyperflexible atraumatic distal tip with optimized proximal stability of the Benchmark intracranial guide catheter for the treatment of cerebral vascular diseases: a technical note

Abstract

Background A stable guide catheter position within the intracranial vasculature is critical for safe, successful endovascular treatment. Objective To present ourinitial experience with the 0.071 inch inner diameter Benchmark guide catheter used in the treatment of intracranial cerebrovascular pathologies, demonstrating its safety and efficacy. Methods We retrospectively reviewed use of the Benchmark guide catheter from September through December 2014 in the management of various neuroendovascular intracranial pathologies. Clinical performance and complication rates were evaluated, with particular consideration of vessel tortuosity. A total of 62 Benchmarks were used, 47 in the anterior circulation, 10 in the posterior circulation, 4 in the external carotid, and 1 in the venous sinus. The five cases with access to the external carotid and venous sinus were excluded. Results The Benchmark was able to cross at least one 90°turn in 49 (86%) of the 57 patients. Reversal of the catheter was seen in 15% of 47 anterior circulation cases (4 at one 90°turn; 3 at two 90°turns). We report no complications of dissection or thromboembolic events. All guide catheter positions were safely achieved over a 0.035 Terumo stiff glidewire without need for an inner smaller lumen guide catheter for navigation. Conclusions Benchmark is a new guide catheter, with an ideal combination of both hyperflexible, atraumatic distal tip and optimized proximal shaft support to provide stable 6F primary access for a successful neurointerventional procedure. Benchmark can be easily, safely, and consistently positioned in a desired location within intracranial arteries providing a stable position for intervention and adequate angiography.

Verification of the Availability of Cerulean DD6

“…Chandran et al reported that kickback of DAC occurred after the procedure, 2) but no kickback was clearly noted in our study, clarifying superior supportability of DD6. DD6 itself acquired a 3D shape due to the shaping and had a fulcrum, being stable, when it was placed in the distal blood vessel, which may also have contributed to the supportability.…”

“…Improvement of the stability and safety of intracranial device operation by the use of DAC as a coaxial system has been reported, [4][5][6] but to apply the adjunctive techniques described above, a 6Fr or larger catheter is necessary. In western countries, several types of 6Fr or larger DAC are now used, 2,3) but in Japan, at present, only DD6 is available.…”

“…The use of a 6Fr large-diameter distal access catheter (DAC) with which adjunctive techniques can be concomitantly used has recently been reported as a measure to solve these problems. 2,3) General large-diameter guiding catheters are placed in the cervical internal carotid artery, whereas 6Fr DAC reaches the intracranial internal carotid artery and it is superior in supportability, contributing to improve intracranial operability of microwire/microcatheter. In this study, we verified the placement procedure and its safety and benefit based on our use experience of 6Fr Cerulean DD6 118 cm (Medikit, Tokyo, Japan), it's available in Japan.…”

Utilization of a Novel, Multi-Durometer Intracranial Distal Access Catheter: Nuances and Experience in 110 Consecutive Cases of Aneurysm Flow Diversion

“…Additionally, the Cat5 catheter is intended to be used as part of a tri-axial system, and it would not be sufficient as the primary guide catheter in a bi-axial system for a transfemoral approach to the cerebral circulation. Other centers have published use of the Benchmark catheter (Penumbra) as part of a bi-axial system for PED cases and other aneurysm treatments [14,15]. Our group prefers tri-axial systems for their greater flexibility (more possible catheter combinations for various anatomy) and improved distal access.…”

Transvenous Shunting Point Embolization of a Superior Sagittal Sinus Dural Arteriovenous Fistula

“…Some studies reported the usefulness of a method to use an intermediate support catheter as a co-axial system in patients with a specific distance to the lesion site, [11][12][13] as demonstrated in the present case. As its merits, the operability of a microcatheter may be improved by reducing microcatheter friction/resistance at the flexed area of an access blood vessel, and an improvement in the supporting performance of a guiding system may facilitate an access to the lesion site.…”