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

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.

Initial experience of using a large-bore (0.096″ inner diameter) access catheter in neurovascular interventions

“…For example, Hassan et al reported their experience using a 0.088″ ID AC in 73 patients, via both femoral and radial approaches, with a 100% technical success rate, but only a collective 8.8% of patients had any form of anatomic tortuosity. 8 Similarly, Lin et al reported use with another 0.088″ ID AC, via a femoral approach, with a 100% technical success rate, but only 12% of patients had significant cervical tortuosity. 9 In a cohort more similar to ours, Rinaldo et al reported the use of a 0.090″ ID AC in 154 patients, via a femoral approach, with a success rate of 98.1% and a combined rate of type II or III aortic arch of 37.3%.…”

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

“…8 9 Previous 0.088 inch guide catheters have been limited by their stability and trackability into the intracranial vasculature. [10][11][12][13][14] This limitation prevents distal placement and enhanced stability for the delivery of large neurointerventional devices. The TracStar Large Distal Platform (LDP) (Imperative Care, Campbell, California, USA) is the first ever supportive 0.088 inch guide catheter with a hyperflexible tip designed to track to the intracranial vasculature.…”