Li-Mei Lin1, Bowen Jiang2, Matthew T Bender2, Erick M Westbroek2, Jessica K Campos2, Rafael J Tamargo3, Judy Huang3, Alexander L Coon3, Geoffrey P Colby4. 1. Department of Neurosurgery, University of California, Irvine School of Medicine, UC Irvine Medical Center, Orange, California, USA. 2. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 3. Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA. 4. Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA.
Abstract
BACKGROUND: The increasing complexity of modern neurointerventions has necessitated a shift in intracranial access techniques towards more robust distal support platforms. Here we present our experience with the Syphontrak Support Catheter (Codman Neuro, Raynham, MA, USA) in the triaxial platform for the implantation of the second-generation Pipeline Flex embolization device (PED Flex; Medtronic Neurovascular, Irvine, CA, USA). METHODS: We retrospectively identified patients who underwent PED Flex treatment utilizing the Syphontrak at a single institution. The procedural data collected included parent artery tortuosity, patient demographics, aneurysm characteristics, other equipment utilized, and catheter-related complications. RESULTS: A total of 47 consecutive aneurysm flow diversions were successfully performed using the Syphontrak. The patients' age ranged from 25 to 80 years (mean 57.3 ± 11.6) and 85% were women. The average aneurysm size was 4.8 ± 2.7 mm (range 2-14). All cases were in the anterior circulation, with 6 (12%) aneurysms located beyond the internal carotid artery termination. Significant cervical carotid tortuosity was present in 23% (11/47) of the cases and moderate-to-severe cavernous tortuosity (cavernous grade ≥2) in 51% (24/47) of the cases. The mean fluoroscopy time was 36.6 ± 14.8 min. In 12/47 cases (26%), vasospasm prophylaxis with intra-arterial verapamil infusion was performed. The Syphontrak was tracked to the intended distal position in all cases, with a 100% technical success of PED Flex implantation. Forty-six (98%) of the 47 patients were discharged home after an average length of stay of 1.38 days. No iatrogenic catheter-related vessel injury occurred. Transient, minor neurological morbidity occurred in 3 cases (6%) and 1 patient had a minor ischemic event (NIHSS score < 4) in the periprocedural period. CONCLUSION: The Syphontrak is a new large-bore, multi-durometer intermediate catheter (IC) designed for use in modern neurointerventional procedures. We have shown its utility in 47 successful cases of PED Flex flow diversion of a wide range of complexity. The IC provides robust and atraumatic distal intracranial access while also providing an enhanced image quality with its large 0.060″ inner diameter.
BACKGROUND: The increasing complexity of modern neurointerventions has necessitated a shift in intracranial access techniques towards more robust distal support platforms. Here we present our experience with the Syphontrak Support Catheter (Codman Neuro, Raynham, MA, USA) in the triaxial platform for the implantation of the second-generation Pipeline Flex embolization device (PED Flex; Medtronic Neurovascular, Irvine, CA, USA). METHODS: We retrospectively identified patients who underwent PED Flex treatment utilizing the Syphontrak at a single institution. The procedural data collected included parent artery tortuosity, patient demographics, aneurysm characteristics, other equipment utilized, and catheter-related complications. RESULTS: A total of 47 consecutive aneurysm flow diversions were successfully performed using the Syphontrak. The patients' age ranged from 25 to 80 years (mean 57.3 ± 11.6) and 85% were women. The average aneurysm size was 4.8 ± 2.7 mm (range 2-14). All cases were in the anterior circulation, with 6 (12%) aneurysms located beyond the internal carotid artery termination. Significant cervical carotid tortuosity was present in 23% (11/47) of the cases and moderate-to-severe cavernous tortuosity (cavernous grade ≥2) in 51% (24/47) of the cases. The mean fluoroscopy time was 36.6 ± 14.8 min. In 12/47 cases (26%), vasospasm prophylaxis with intra-arterial verapamil infusion was performed. The Syphontrak was tracked to the intended distal position in all cases, with a 100% technical success of PED Flex implantation. Forty-six (98%) of the 47 patients were discharged home after an average length of stay of 1.38 days. No iatrogenic catheter-related vessel injury occurred. Transient, minor neurological morbidity occurred in 3 cases (6%) and 1 patient had a minor ischemic event (NIHSS score < 4) in the periprocedural period. CONCLUSION: The Syphontrak is a new large-bore, multi-durometer intermediate catheter (IC) designed for use in modern neurointerventional procedures. We have shown its utility in 47 successful cases of PED Flex flow diversion of a wide range of complexity. The IC provides robust and atraumatic distal intracranial access while also providing an enhanced image quality with its large 0.060″ inner diameter.
Authors: Li-Mei Lin; Matthew T Bender; Geoffrey P Colby; Narlin B Beaty; Bowen Jiang; Jessica K Campos; Judy Huang; Rafael J Tamargo; Alexander L Coon Journal: J Neurointerv Surg Date: 2017-07-14 Impact factor: 5.836
Authors: Geoffrey P Colby; Li-Mei Lin; Risheng Xu; Narlin Beaty; Matthew T Bender; Bowen Jiang; Judy Huang; Rafael J Tamargo; Alexander L Coon Journal: Interv Neurol Date: 2017-02-03
Authors: Li-Mei Lin; Geoffrey P Colby; Matthew T Bender; Risheng Xu; Judy Huang; Rafael J Tamargo; Alexander L Coon Journal: J Neurointerv Surg Date: 2017-02-01 Impact factor: 5.836
Authors: Geoffrey P Colby; Li-Mei Lin; Justin M Caplan; Bowen Jiang; Barbara Michniewicz; Judy Huang; Rafael J Tamargo; Alexander L Coon Journal: J Neurointerv Surg Date: 2015-05-18 Impact factor: 5.836
Authors: Faysal Benali; Robert-Jan B Goldhoorn; Bart A J M Wagemans; Christiaan van der Leij; Rutger J B Brans; Sanne W de Boer; Michiel W de Haan; Wim H van Zwam Journal: Cardiovasc Intervent Radiol Date: 2019-07-02 Impact factor: 2.740