Volume 169, January 2023, Pages 32-35Author links open overlay panelBackground

A method of guiding an intermediate catheter from a new alpha-type guiding catheter placed in the ascending aorta to the carotid artery is evaluated in neuroendovascular treatment in challenging anatomic directions of the guiding catheter, such as the bovine aortic arch and type III aortic arch.

Methods

The existing 8-Fr guiding catheter was given a strong bending shape at the tip to make it an alpha type. The total length of the catheter was 85 cm. This guiding catheter was inserted into the ascending aorta to verify whether a 6-Fr intermediate or aspiration catheter could be coaxially guided into the right and left internal carotid arteries. A silicone vascular model was used for evaluation and in actual clinical cases.

Results

Creating an alpha shape of the catheter at the aortic arch was very easy. The inner catheter could be easily guided from the brachiocephalic artery to the right common carotid artery by pushing the alpha shape guiding catheter toward the aortic valve. The catheter was easily guided into the left common carotid artery when the α-guide was pulled a little bit backward. The 0.071-inch lumen aspiration catheter reached the bilateral middle cerebral arteries.

Conclusions

The 8-Fr alpha shape guiding catheter quickly guides the inner catheter into the bovine and the type III aortic arch by looking up from the ascending aorta.

Introduction

Guiding and stabilizing a guiding catheter from the femoral artery to the carotid artery is often difficult in patients with severe atherosclerosis. Anatomical factors, such as a bovine arch and a type III aortic arch in the usual coaxial technique, contribute to this difficulty. Therefore, we use the distal guidewire insertion, catheter exchange techniques, manual carotid artery compression,1 Simmons-type internal catheter, coaxial techniques using microcatheters, and balloon flow navigation in these situations.2 We wondered if an upward approach from the ascending aorta would be possible in this anatomically challenging situation for guiding catheters. Therefore, this study aimed to guide the intermediate catheter into the carotid artery from an alpha guiding catheter placed in the ascending aorta instead of stabilizing the guiding catheter in the carotid artery as the convention.

Section snippetsMaterial and Methods

The tip of the 8-Fr ROADMASTER (NIPRO CORPORATION, Osaka, Japan) was modified to have a strong alpha-type bend at the manufacturing stage. Numerous prototypes of the alpha guide were made, including catheter hardness, angle, length, and bend direction, and the appropriate conditions were verified using a silicone vascular model (EVE: FAIN-Biomedical Inc., Okayama, Japan). The tip of the alpha shape guiding catheter was placed in the ascending aorta, from which a coaxial 6-Fr intermediate or

Results1)

After evaluating some prototype models, the final model was made based on the selectivity of each vessel and its stability in the aortic arch (Video 1). The total length of the catheter was 85 cm. The alpha shape guiding catheter was placed to contact the entire course of the aortic arch, thus it was stable without selecting each vessel. The apical loop was maintained and stabilized even with resistance to the device in the peripheral vessels, such as the neck and intracranium.

2)

The REACT 71

Discussion

One of the factors that make endovascular treatment challenging is the difficulty in navigating and stabilizing a guiding catheter, such as the type III aortic arch and bovine arch. Thicker guiding catheters in some cases do not follow, even with Simmons-type inner catheters and other devices. Hence, any aortic arch would be effective if the catheter could be guided to look up from the aortic valve position. Therefore, we designed a guiding catheter that would guide the intermediate or

Conclusions

The 8-Fr alpha shape guiding catheter quickly guides the inner catheter into the bovine and the type III aortic arch by looking up from the ascending aorta. The effective use of this new concept of guiding catheters awaits the development of dedicated long inner and aspiration catheters.

CRediT authorship contribution statement

Tomotaka Ohshima: Conceptualization, Methodology, Writing – original draft. Tetsuya Ioku: Data curation, Visualization, Investigation. Mao Yokota: Data curation, Visualization, Investigation. Reo Kawaguchi: Data curation, Visualization, Investigation. Naoki Matsuo: Data curation, Visualization, Investigation. Shigeru Miyachi: Supervision, Writing – review & editing.

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