P-017 Intermediate catheters: experience, cost and complication rates at two high volume centers
Authors: Hui F , Cawley M , Dion J , Rasmussen P , Moskowitz S , Toth G , Hussain S , Schuette J , Spiotta A , Tong F 
Published: July 2011

IntroductionStable access to target lesions is foundational to endovascular therapy, be it in hemorrhagic or ischemic disease. Continued evolution in access technology has resulted in next generation catheters that afford improved trackability, as well as distal and proximal support. Neuron guide catheter family and the Concentric Outreach Distal Access Catheter fall into this category of hybrid catheters. Both families of devices possess overlapping characteristics allowing operators to achieve a more stable proximal access complex.MethodsA retrospective review of 608 cases in which an intermediate catheter was used during 2008–2010 at Cleveland Clinic (Cleveland, OH) and throughout 2010 at Emory University Hospital (Atlanta, GA) was conducted, and the cases classified by indication. Catheter placement, distal most location and related complications were recorded and experience summarized. We also review the differences in the catheters and the rationale for catheter selection, as well as relative costs for each approach.ResultsA total of 311 Neuron 053, 166 Neuron 070, 36 DAC 3.9 Fr, 61 DAC 4.3 Fr, and 34 DAC 5.2 Fr catheters were deployed. Of these, 459 placements were in the anterior circulation, 130 in the posterior circulation, 11 in the external carotid artery, and eight were used intravenously. Abstract P-017 table 1 summarizes the clinical scenarios where the catheters were used, Abstract P-017 table 2 the distal most placements, Abstract P-017 table 3 the complications and Abstract P-017 table 4 the estimated costs for a typical catheter selection. Complication rates were 9/131 (6.9%) for the DAC catheter group, 16/311 (5.1%) for the Neuron 053 group, and 14/166 (8.4%) for the Neuron 070 group with p=0.37, χ2test Abstract P-017 table 5.Abstract P-017 Table 1Clinical scenariosCatheter# CasesAneurysmStrokeAVMAVSICADTumorEpiVenousDXSpasmSacDAC131244231821301010Neuron 05331116216251273621176Neuron 070166117221135100304AVM, Arteriovenous Malformation; AVS, Arteriovenous Shunts, including Cavernous Carotid Fistulae and Dural Arteriovenous shunts; ICAD, Intracranial Stenoses including in stent restenoses; Epi, Epistaxis; Venous, Sinus Thrombosis; DX, Diagnostic Procedures including Balloon Test Occlusions; Spasm, Vasospasm; Sac, Vessel Sacrifice.Abstract P-017 Table 2Distal most placementCatheter# CasesCervical ICAPetrous ICACav/Com SupraClin ICAM1/A1M2/A2VertBasilarPCASCA/PICA/AICAECAVeinDAC13100345861336125Neuron 053311791113128410174Neuron 0701661710918002000020Abstract P-017 Table 3Complication ratesCatheter# Cases# ComplicationsDAC1319 (6.9%)Neuron 05331116 (5.1%)Neuron 07016614 (8.4%)p=0.37, χ2testAbstract P-017 Table 4Relative costsCombinationCost6F Sheath, SL-10, 6F Envoy, Synchro-2 microwire16F Sheath, 6F Envoy, DAC, SL-10, Synchro-2 microwire1.436F Sheath, Neuron 053, SL-10, Synchro-2 microwire1.15*Based on prices available at Cleveland Clinic.Abstract P-017 Table 5ComplicationsDACNeuron 053Neuron 070# Cases131311166# Complications9 (6.9%)16 (5.1%)14 (8.4%)Air embolus1 (0.8%)0 (0.0%)0 (0.0%)Dissection2 (1.6%)2 (0.6%)1 (0.6%)Inadvertant embolization3 (2.4%)0 (0.0%)3 (1.8%)Extravasation/Perforation2 (1.6%)6 (1.8%)4 (2.4%)Intraparenchymal hemorrhage1 (0.8%)2 (0.6%)0 (0.0%)Clot-on-coil0 (0.0%)2 (0.6%)2 (1.2%)Parent vessel compromise0 (0.0%)4 (1.2%)2 (1.2%)Distal stroke0 (0.0%)0 (0.0%)2 (1.2%)ConclusionNext generation access catheters possess characteristics that blend qualities of traditional microcatheters and guide catheters. These “intermediate catheters” represent a class of access devices that allow for better catheter support, and allow for multi-axial access techniques. The utility of these catheters must be balanced against costs. The increased procedural complexity involved in using multi-axial techniques should also be a consideration, but judicious application should prove beneficial to patients. There is no statistically significant difference in complication rates when using these catheters as well as comparable complication rates when compared to historical complication rates quoted to patients.