Neurointervention.  2017 Sep;12(2):91-99. 10.5469/neuroint.2017.12.2.91.

Optimal Guiding Catheter Length for Endovascular Coiling of Intracranial Aneurysms in Anterior Circulation in Era of Flourishing Distal Access System

• Jia ZY
• Lee SH
• Kim YE
• Choi JH
• Hwang SM
• Lee GY
• Youn JH
• Lee DH

• KMID: 2389501
• DOI: http://doi.org/10.5469/neuroint.2017.12.2.91

Abstract

PURPOSE
To determine the minimum required guiding catheter length for embolization of various intracranial aneurysms in anterior circulation and to analyze the effect of various patient factors on the required catheter length and potential interaction with its stability.
MATERIALS AND METHODS
From December 2016 to March 2017, 90 patients with 93 anterior circulation aneurysms were enrolled. Three types of guiding catheters (Envoy, Envoy DA, and Envoy DA XB; Codman Neurovascular, Raynham, MA, USA) were used. We measured the in-the-body length of the catheter and checked the catheter tip location in the carotid artery. We analyzed factors affecting the in-the-body length and stability of the guiding catheter system.
RESULTS
The average (±standard deviation) in-the-body length of the catheter was 84.2±5.9 cm. The length was significantly longer in men (89.1±5.6 vs. 82.1±4.6 cm, P<0.001), patients older than 65 years (87.7±7.8 vs. 82.7±4.2 cm, P<0.001), patients with a more tortuous arch (arch type 2 and 3) (87.5±7.4 vs. 82.7±4.4 cm, P<0.001), and patients with a distal aneurysm location (distal group) (86.2±5.0 vs. 82.7±6.1 cm, P=0.004). A shift in the tip location was noted in 19 patients (20.4%); there was no significant different among the 3 catheters (P=0.942).
CONCLUSION
The minimum required length of a guiding catheter was 84 cm on average for elective anterior-circulation aneurysm embolization. The length increased in men older than 65 years with a more tortuous arch. We could reach a higher position with distal access catheters with little difference in the stability once we reached the target location.

Keyword

Cerebral aneurysm; Endovascular treatment; Guiding catheter; Intermediate catheter; Distal access catheter

MeSH Terms

Aneurysm
Carotid Arteries
Catheters*
Humans
Intracranial Aneurysm*
Male

Figure

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  Fig. 1 A schematic diagram showing arbitrary segmentation of the carotid artery from the distal common carotid artery to the intradural internal carotid artery right below the bifurcation (segments 1 to 8). We dichotomized the segments into the lower position (segments 1 to 5) and higher position (segments 5 to 8) using the genu of the petrous segment of the internal carotid artery as the landmark.

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