E-026 Utilization of a large-bore 088 intracranial access catheter for complex neurointervention: experience with the tracstar LDP^TM in 127 consecutive cases

Background The delivery of complex neuroendovascular devices requires a robust proximal access platform. This demand has previously been met with a 6Fr long-sheath (8Fr guide) that is placed in the proximal ICA (high cervical) or vertebral artery (V1/2) segments. We share our experience with the first 088 8Fr guide catheter designed specifically for direct intracranial access. Methods We retrospectively reviewed a prospectively-maintained IRB-approved institutional database of the senior authors to identify all cases where the TracStar LDP (Imperative Care, Campbell, CA) was utilized. Case details were recorded including patient demographics, case type, and distal location achieved with navigation of the guide catheter. Technical success was defined as safe placement of the guide catheter to at least the petrous (anterior circulation) or vertebral artery (V3) segments (posterior circulation) or the transverse sinus for venous stenting procedures. Results Over the 14-month study period, 127 femoral access cases were identified where the TracStar LDP guide catheter was utilized for aneurysm treatment (80% of cases, 102/127 ), intracranial angioplasty/stenting (13% of cases, 17/127), venous sinus stenting (3% of cases, 4/127), and other pathologies (3% of cases, 4/127). All cases utilized a direct select catheter technique for placement (no exchange). Posterior circulation placement occurred in 14% of cases (18/127). Technical success was achieved in 97% of cases (123/127). Of the 4 cases with technical failure, 75% (3/4) were in the posterior circulation and were attributed to tortuous proximal subclavian access or a small caliber vertebral origin. No symptomatic or flow-restricting vessel dissections occurred in any of the cases. Conclusion The TracStar LDP is a safe and effective means for establishing direct 088 intracranial access. This can be achieved in a wide range of cases with extremely high rates of technical success. Disclosures J. Campos: None. Z. Hsu: None. D. Zarrin: None. K. Golshani: None. N. Beaty: 2; C; Medtronic Neurovascular, Stryker Neurovascular. M. Bender: None. G. Colby: 2; C; Medtronic Neurovascular, MicroVention-Terumo, Stryker Neurovascular. L. Lin: 2; C; Medtronic Neurovascular, MicroVention-Terumo, Stryker Neurovascular. A. Coon: 2; C; Avail MedSystems, Imperative Care, InNeuroCo, Medtronic Neurovascular, MicroVention-Terumo, Q’apel, Rapid Medical, Stryker Neurovascular.