title: Biaxial system using the Benchmark intracranial guide catheter for placement of a Pipeline Embolization Device for intracranial aneurysms.
abstract: BACKGROUND
  The Benchmark (Penumbra, Alameda, CA) is a novel intracranial guide catheter that provides optimized proximal stability combined with a hyperflexible and atraumatic tip. We assessed the use of a biaxial catheter system consistent with the Benchmark and Marksman microcatheter for placement of a Pipeline embolization device (PED) for intracranial aneurysms.
  
  
  METHODS
  We reviewed consecutive patients with aneurysms undergoing Pipeline embolization for an aneurysm using the biaxial system from April to October 2015 at a major academic institution in the United States. Benchmark performance was measured by the number of 90° turns the catheter could safely cross. Landing and final positions of the Benchmark were recorded.
  
  
  RESULTS
  A total of 26 procedures were performed in 25 patients (mean age 59.5 ± 10.3 years; male:female = 1:4). In one case (3.8%) the biaxial system had to be substituted for a traditional triaxial system. The Benchmark was able to cross one, two, or three 90° turns in 48%, 40%, and 8% of cases, respectively. There was one (3.8%) thromboembolic event and no arterial dissections. In the period from January 2014 to March 2015 and prior to adopting the biaxial system we encountered three thromboembolic events (6.4%) and one (2.1%) dissection potentially related to the triaxial system in 47 PED procedures.
  
  
  CONCLUSIONS
  Preliminary experience shows that a biaxial system using the Benchmark is a safe and efficacious alternative to the traditional triaxial guide catheter system for placement of PED and may reduce the complexity and duration of the procedure.
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, USA.
authors.forename: Apar S
authors.initials: AS
authors.lastname: Patel
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, USA christoph.griessenauer@gmail.com.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ogilvy
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, USA.
authors.forename: Ajith J
authors.initials: AJ
authors.lastname: Thomas
mesh_terms: D057785:Catheters; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Catheter; aneurysm; complication; dissection; flow diverter