title: Flexible tip guides and intermediate catheters: two center experience and a proposed taxonomy.
abstract: BACKGROUND
  Stable access to target lesions is foundational to endovascular therapy, be it in hemorrhagic or ischemic disease. Continued evolution in access technology has resulted in next generation catheters that afford improved trackability and proximal support.
  
  
  OBJECTIVE
  Assess safety and patterns of use at two high volume centers, and conceptualize usage patterns.
  
  
  METHODS
  A retrospective review of 608 cases in which a 'next generation' catheter was used during 2008-2010 at Cleveland Clinic (Cleveland, Ohio, USA) and throughout 2009-2010 at Emory University Hospital (Atlanta, Georgia, USA) was conducted, and the cases classified by indication. Catheter placement, distal most location, and related complications were recorded and experience summarized. We also reviewed the differences in the catheters and the rationale for catheter selection, as well as relative costs for each approach.
  
  
  RESULTS
  311 Neuron 053, 166 Neuron 070, 36 distal access catheter (DAC) 3.9 F, 61 DAC 4.3 F, and 34 DAC 5.2 F catheters were deployed. Of these, 459 placements were in the anterior circulation, 130 in the posterior circulation, 11 in the external carotid artery, and eight were used intravenously. Complication rates were 9/131 (6.9%) for the DAC catheter group, 16/311 (5.1%) for the Neuron 053 group, and 14/166 (8.4%) for the Neuron 070 group (p=0.37, χ(2) test).
  
  
  CONCLUSIONS
  Next generation access catheters possess characteristics that blend qualities of traditional microcatheters and stiff guide catheters. There was no statistically significant difference in complication rates between the various catheter families in this small retrospective review, and the complication rates were similar to historical complication rates.
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Ferdinand K
authors.initials: FK
authors.lastname: Hui
authors.affiliation: Department of Neurosurgery, Tripler Army Medical Center, Honolulu, Hawaii, USA.
authors.forename: A Jesse
authors.initials: AJ
authors.lastname: Schuette
authors.affiliation: Department of Neurosciences, Division of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Alejandro M
authors.initials: AM
authors.lastname: Spiotta
authors.affiliation: Mechanical and Fluid Systems Division, NASA Glenn Research Center, Cleveland, Ohio, USA.
authors.forename: John
authors.initials: J
authors.lastname: Yim
authors.affiliation: Quantitative Health Services, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Obuchowski
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Rasmussen
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Mohammed Shazam
authors.initials: MS
authors.lastname: Hussain
authors.affiliation: Department of Radiology, Emory University, Atlanta, Georgia, USA Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.
authors.forename: C Michael
authors.initials: CM
authors.lastname: Cawley
authors.affiliation: Department of Radiology, Emory University, Atlanta, Georgia, USA Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.
authors.forename: Jacques E
authors.initials: JE
authors.lastname: Dion
authors.affiliation: Department of Radiology, Emory University, Atlanta, Georgia, USA Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.
authors.forename: Frank C
authors.initials: FC
authors.lastname: Tong
mesh_terms: D002545:Brain Ischemia / Q000628:therapy*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000706:statistics & numerical data; D006801:Humans; D020300:Intracranial Hemorrhages / Q000628:therapy*; D062666:Vascular Access Devices / Q000009:adverse effects / Q000145:classification / Q000592:standards
keywords: Balloon