Pentaxial access platform for ultra-distal intracranial delivery of a large-bore hyperflexible DIC (distal intracranial catheter): A technical note

Background: Intracranial access techniques in modern neurointervention are shifting towards more robust access platforms. We present in this report a novel method of navigating a 5 French distal intracranial catheter (DIC) deep within the intracranial circulation in an atraumatic fashion via a pentaxial access system. Methods: We retrospectively reviewed all neurointerventions performed at two author institutions identifying all aneurysm treatments where the pentaxial system was used to build the catheter support for intracranial positioning of a 5 French DIC. Procedural data collected include parent artery tortuosity, use of vasodilator, intra-procedural DIC position, and peri-procedural complications. Results: The pentaxial access platform provided ultra-distal intracranial navigation of the 5 French DIC in the following 11 neurointerventions for treatment of anterior circulation aneurysms: Pipeline embolization device (PED) for anterior communicating artery (ACom) aneurysm, n = 2; surpass for large internal carotid artery (ICA) aneurysm, n = 4; Woven EndoBridge (WEB) device for ACom aneurysm, n = 5. Mean patient age was 55 ± 11 years (range 40–75 years). Mean aneurysm size was 6.7 mm ± 3.8 mm (range 2–16 mm). Mean fluoroscopy time was 29 ± 16.7 min. Intra-procedural DIC positions achieved included supraclinoid ICA (n = 6), M1 (n = 4), and A1 (n = 1). No significant catheter-related complications occurred. Conclusion: Distal intracranial catheters can achieve ultra-distal intracranial positions safely with the pentaxial access platform. This technique is a near no step-off, atraumatic method of navigating a DIC in a stepwise fashion over de-escalating smaller diameter catheters via a microwire. Familiarity with catheter specifications including diameters and length is essential for the success of this system.