J Cerebrovasc Endovasc Neurosurg.  2016 Sep;18(3):234-238. 10.7461/jcen.2016.18.3.234.

The Benefits of Navienâ„¢ Intracranial Support Catheter for Endovascular Treatment

• Lee S
• Gong TS
• Lee YW
• Kim HJ
• Kweon CY

• KMID: 2355647
• DOI: http://doi.org/10.7461/jcen.2016.18.3.234

Abstract

OBJECTIVE
Endovascular treatment is one of the most important treatments along with open craniotomy for cerebrovascular surgery. The successful treatment of endovascular disease relies on appropriate instruments and the surgeon's skill. Endovascular treatment needs to provide safe and stable access to the catheter cavity. Additionally, it is important to maintain a round shape without changing to an oval shape. The catheter for endovascular treatment has to be flexible and accommodate at least 0.027 inches of inner diameter. The 6-Fr Navienâ„¢ Intracranial Support Catheter (formerly the ReFlex Intracranial Catheter; Covidien Vascular Therapies, Mansfield, MA, USA) provides 0.072 inches of inner diameter.
MATERIALS AND METHODS
We reviewed 61 cases for 56 cases of endovascular treatment with a Navien catheter. A triaxial system was used for all procedures with femoral arterial access. The Navien catheter was placed in the petrous segment of the internal carotid artery or third segment of the vertebral artery. The patients had various shapes of intracranial arteries, including tortuous vessels.
RESULTS
The Navien catheter was used for 61 cases of endovascular treatment. We had 59 cases of coil embolization at unruptured and ruptured aneurysms and two cases of stent insertion into the middle cerebral artery. All the cases were successful without any catheter-related complications.
CONCLUSION
The Navien catheter is a recently developed catheter that has several strengths compared with previously developed catheters. It provides a more stable environment for endovascular treatment. It provides a cavity sufficient for endovascular treatment devices. Additionally, it is sufficiently flexible to approach tortuous vessels.

Keyword

Endovascular procedure; Intracranial aneurysm; Vascular access devices

MeSH Terms

Aneurysm, Ruptured
Arteries
Carotid Artery, Internal
Catheters*
Craniotomy
Embolization, Therapeutic
Endovascular Procedures
Humans
Intracranial Aneurysm
Middle Cerebral Artery
Reflex
Stents
Vascular Access Devices
Vertebral Artery

Figure

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  Fig. 1 Navien support during coil embolization of an unruptured aneurysm on the right internal carotid artery (ICA) bifurcation site in a 76-year-old female. (A) Right common carotid artery (CCA) transfemoral cerebral angiogram (TFCA) showing significant tortuosity of the proximal part. (B) Pre-embolization TFCA showing 3.5 × 3.0-mm-sized aneurysm on the right ICA bifurcation site. Navien catheter was placed on the petrous segment of right ICA. (C) Post-embolization TFCA showing a totally occluded aneurysmal sac.

• 

  Fig. 2 Navien support during stent-assisted coil embolization of an unruptured aneurysm on basilar top in a 70-year-old female. (A) Left vertebral artery (VA) transfemoral cerebral angiogram (TFCA) showing significant tortuosity of the proximal part. (B) Pre-embolization TFCA showing 8.2 × 7.6 mm-sized aneurysm on the basilar top. The aneurysmal sac originated from both posterior cerebral artery (PCA) and superior cerebellar artery (SCA). Navien catheter was placed on the third segment of VA. (C) Post-embolization TFCA showing partially occluded aneurysmal sac. Both PCA and SCA flow were maintained.

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  Fig. 3 Navien support during stent-assisted coil embolization of an unruptured aneurysm on the left proximal anterior cerebral artery in a 79-year-old female. (A) A TFCA showing significant vasospasm post-Navien positioning in the petrous ICA. (B) It returned to normal status immediately after nimodipine (1 mg/5 mL) injection without any post-operative clinical complications. TFCA = transfemoral cerebral angiogram, ICA = internal carotid artery.

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