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Neuroradiology (2007) 49:563566 DOI 10.1007/s00234-007-0233-1
INTERVENTIONAL NEURORADIOLOGY
A 6F guide sheath for endovascular treatment of intracranial aneurysms
Raphal Blanc & Frdric Deschamps &
Julita Orozco-Vasquez & Philippe Thomas &
Andr Gaston
Received: 28 November 2006 / Accepted: 20 March 2007 / Published online: 19 April 2007 # Springer-Verlag 2007
Abstract Introduction Stable insertion of guide catheters via the femoral route can prove difficult because of tortuous vasculature leading to failure of endovascular treatment of intracranial aneurysms.Methods and results We report our experience using a long braided introducer sheath (6F Terumo Destination) with an inner diameter of 0.087 inches. It allowed the simultaneous use of multiple catheters or adjunctive techniques (balloon-assisted or stent-assisted coiling) while providing excellent support in 60 procedures involving coiling of anterior circulation aneurysms.Conclusion The use of a long introducer sheath, by enhancing stability in the aortic arch and supraaortic vessels, provides another solution to the problem of vascular tortuosity that hinders endovascular treatment of intracranial lesions.
Keywords Intracranial aneurysms . Arterial access
Introduction Use of multiple catheters or adjunctive techniques (balloon-assisted or stent-assisted coiling) has become widely
accepted for endovascular treatment of cerebral aneurysms. The common method of access to the intracranial vasculature is via a femoral arterial route, using a guide catheter. However, in certain patients, the tortuous anatomy of the aortic arch hampers endovascular treatment because of instability of the guide catheter. To overcome these difficulties, we have over time considered accessing the supraaortic vessels and intracranial arteries via a more stable guide catheter, i.e. one with a long introducer sheath that prevents slipping and buckling of the catheter back into the aorta. In this study, we report a series of 60 intracranial procedures performed with the aid of the Terumo Destination guide sheath (Terumo Corporation, Tokyo, Japan), a system that provides enhanced support, thus increasing the stability and navigability of the microcatheters. Furthermore, the large inner lumen allows the simultaneous introduction of two or even three microcatheters.
Technique The 6F Terumo Destination guide sheath is a kink-resistant braided sheath with an external diameter of0.109 inches and an inner diameter of 0.087 inches. It has a hydrophilic coating, an inner lumen lined with PTFE, and a soft tip with a radiopaque gold marker 5 mm from the tip. It is...