Introduction
: Larger‐bore access catheters can improve endovascular therapy by facilitating delivery of interventional devices and reducing the number of exchange maneuvers needed. Advances in technology have allowed for the manufacture of larger‐bore access catheters that maintain necessary performance characteristics, such as a stiffer proximal segment for stability and a flexible distal segment for vessel catheterization. The purpose of this study was to report our initial experience of using a large‐bore (0.096” inner diameter) access catheter in neurovascular interventions.
Methods
: Data were prospectively collected from 7 sites in the US for procedures performed using a large‐bore (0.096” inner diameter) access catheter from January 15, 2020, to April 21, 2021. Effectiveness outcome was technical success, defined as successful access to the target vessel. Safety outcomes were access‐related and device‐related related complications.
Results
: One hundred and fourteen patients were included in this study (Table). The mean age of the patients was 67.6 years (SD 16.1), and about half (49.6%, 56/113) were female. The most common treatment conditions were stroke, 64 (56.1%); aneurysm, 24 (21.1%); carotid atherosclerosis, 19 (16.7%); and intracranial atherosclerosis, 3 (2.6%). Most approaches were by the femoral (66.4%, 73/110) or radial (33.6%, 37/110) artery and the most common target vessels were the left (49.1%, 55/112) or right (42.9%, 48/112) carotid artery. Anatomic variations included severe vessel tortuosity (32.1%, 26/81), type 2 aortic arch (19.3%, 17/88), type 3 aortic arch (15.9%, 14/88), bovine arch (15.4%, 16/104), severe angle (<30°) between the subclavian and target vessel (14.9%, 11/74), and subclavian loop (8.9%, 7/79). The median access time to branch was 18 minutes (IQR 11–28, N = 75). The most common treatments were mechanical thrombectomy, 51 (44.7%); stenting, 25 (21.9%); Pipeline/flow diversion, 10 (8.8%); and stent‐assisted coiling, 8 (7.0%). Technical success was achieved in most (94.7%, 108/114) patients. Access site complications occurred in 3 patients (2.6%). Two complications (1.8%) were related to the large‐bore access catheter.
Conclusions
: A large‐bore (0.096” inner diameter) access catheter could be used with both femoral and radial arterial approaches, had a high technical success rate, and had a low rate of periprocedural complications.