J Cerebrovasc Endovasc Neurosurg.  2019 Mar;21(1):5-10. 10.7461/jcen.2019.21.1.5.

Advantages and disadvantages of the ENVOY 6F distal access guiding catheter in endovascular coiling for anterior circulation aneurysms

• Baek JW
• Jin SC
• Kim ST
• Heo YJ
• Han JY
• Seo JH
• Paeng SH
• Kim JS
• Jeong HW
• Jeong YG

• KMID: 2465009
• DOI: http://doi.org/10.7461/jcen.2019.21.1.5

Abstract

OBJECTIVE
Selecting an appropriate guiding catheter to provide both sufficient supportability for working devices and sufficient distal navigability is essential for ensuring the success of a procedure. This study aimed to evaluate the advantages and disadvantages of using the ENVOY 6F distal access (DA) guiding catheter in coil embolization of anterior circulation cerebral aneurysms.
METHODS
We included 98 patients (72 [73.5%] women, median age: 63 [range: 25-84] years) who underwent endovascular coiling with the ENVOY 6F DA guiding catheter from May to November 2016. We analyzed data on patient demographics and the number of co-axial techniques to position the guiding catheter, initial and final location of the catheter, and complications related to the catheter.
RESULTS
The co-axial technique was used to position the ENVOY 6F DA guiding catheter in the internal carotid artery (ICA) in 20 cases (20.41%). The initial position of the ENVOY 6F DA guiding catheter involved the cervical ICA (79.6%), horizontal petrous ICA (17.3%), and vertical petrous ICA (3.1%). Final control angiograms after endovascular coiling showed proximal change in the final, compared to the initial, position of the ENVOY 6F DA guiding catheter in 25 cases (25.51%). Procedure-related complications were observed in nine patients (9.18%), involving vasospasm in all cases; however, there was no symptomatic case.
CONCLUSION
The ENVOY 6F DA guiding catheter had relatively sufficient distal navigability without symptomatic procedural complications. However, the change in the catheter position after endovascular coiling denoted insufficient supportability.

Keyword

Carotid Artery; Internal; Catheterization; Intracranial Aneurysm; Cerebrovascular Circulation

MeSH Terms

Aneurysm*
Carotid Arteries
Carotid Artery, Internal
Catheterization
Catheters*
Cerebrovascular Circulation
Demography
Embolization, Therapeutic
Female
Humans
Intracranial Aneurysm

Figure

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  Fig. 1 Anteroposterior view of the internal carotid artery (ICA). The CA was divided into five segments. It was divided into three segments between the carotid bifurcation and the 90° curve of the petrous segment, and the petrous segment was divided into two segments, a horizontal and a vertical portion.

• 

  Fig. 2 Illustrative case. A woman aged 77 years with acute subarachnoid hemorrhage and a ruptured anterior communicating artery aneurysm underwent right internal carotid artery (ICA) angiography. (A) There were two acute turns on the right ICA roadmap image. (B) After careful navigation, the ENVOY 6F DA guiding catheter was located at the vertical petrous segment (segment number 4 according to our classification) without any complications on right ICA angiography.

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