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Novel Small-Bore Preshaped Guiding Sheath for Transradial Anterior Circulation Interventions: A New Device and
Takuya Nakamura1, Yoshiki Hanaoka2, Jun-Ichi Koyama3
1Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
Background And Importance:
The transradial approach is increasingly used for neurointerventions; nevertheless, a large-bore system can lead to access site complications. To reduce these risks, we developed a novel radial-specific small-bore guiding sheath, the 4F Axcelguide Stiff-J-20. Here, we present the first case and technique using this device for an anterior circulation aneurysm.
Clinical Presentation:
In this study, we used the 4F Axcelguide Stiff-J-20 guiding sheath (outer diameter, 2.03 mm/0.080″; inner diameter, 1.65 mm/0.065″; usable length, 115 cm) for 2 patients. This sheath features a 20-cm Simmonds-shaped bending zone, allowing catheterization of the high cervical internal carotid artery. Coil embolization was performed for 2 patients: a 59-year-old man with an unruptured right middle cerebral artery bifurcation aneurysm and 52-year-old man with an unruptured left ICA-posterior communicating artery aneurysm. After the 4F Axcelguide Stiff-J-20 was engaged in the target internal carotid artery, a triaxial system (4F Axcelguide Stiff-J-20/3.2F Tactics Intermediate Catheter/Single Microcatheter) was constructed. Coil embolization was performed using a simple technique. Intraprocedural system instability and catheter kinking did not occur. No patient experienced access-site complications, and the postprocedural course was uneventful.
Conclusion:
The 4F Axcelguide Stiff-J-20 guiding sheath can achieve sufficient stability and kink resistance, while reducing the risk of access site complications. This device could be a useful therapeutic option for neurointervention.
