[Guide Catheters and Distal Access Catheters in Neuroendovascular Therapy: Structural Characteristics and Selection...

Guiding and distal access catheters (DACs) play a fundamental yet often underrecognized role in neuroendovascular therapy by supporting device maneuverability, procedural stability, and vascular protection. Although attention frequently centers on microcatheters, coils, and flow diverters, procedural success depends on guiding system configuration and meticulous preoperative planning. This review summarizes structural characteristics and selection principles of guiding catheters and DAC from both practical and educational perspectives. Three factors-size, length, and stiffness-determine guiding catheter stability, navigability, and vascular safety. A rational selection process tailored to the vascular anatomy and treatment strategy was outlined, including the use of balloon-guiding catheters for proximal flow control and guiding sheaths that allow sheathless operation while reducing puncture-site complications. This section on DACs highlights their role in overcoming vessel tortuosity, improving distal support, and enhancing microcatheter control and reproducibility. Advances in thin-wall construction and graded flexibility have improved distal reach while preserving support, although potential risks, such as contrast-induced encephalopathy and vessel injury, warrant caution. Ultimately, selection of the optimal guiding system reflects not only technical preference but also procedural strategy and clinical judgment. Systematizing these principles transforms individual experiences into structured, teachable knowledge and promotes safer and more reproducible neuroendovascular practices.