Initial experience with distal guide catheter placement in the treatment of cerebrovascular disease: clinical safety and efficacy

Background Advancements in technology have created a current generation of guide catheters that not only provide stable access but also allow navigation of tortuous portions of the carotid siphon facilitating more distal access. Clinical experience since the release of the current generation of guide catheters was reviewed to determine their safety and efficacy. Methods Between October 2007 and November 2011, all neurointerventional procedures requiring access to the intracranial arterial circulation performed at our institution were reviewed. Clinical performance and complication rates of current generation guide catheters were compared with conventional guide catheters. Results 1188 neurointerventional procedures were performed, of which 659 were eligible for this study. When navigating the anterior circulation, intracranial purchase was achieved significantly more often with current generation 0.070 inch and 0.053 inch guide catheters compared with conventional guide catheters. Similarly, current generation 0.070 inch and 0.053 inch catheters navigated at least one sharp 90 turn significantly more often than conventional guide catheters. Guide catheter related complications were encountered in 1.4% of cases with both catheter generations and differences were not significant although more complications were found when guide catheter tip position was cervical rather than intracranial. Conclusion Current generation guide catheters allow distal access with a high rate of success while maintaining a low rate of complications. When intracranial location of the guide catheter was obtained, fewer complications occurred.