BACKGROUND The increasing complexity of modern neurointerventions has necessitated a shift in intracranial access techniques towards more robust distal support platforms. Here we present our experience with the Syphontrak Support Catheter (Codman Neuro, Raynham, MA, USA) in the triaxial platform for the implantation of the second-generation Pipeline Flex embolization device (PED Flex; Medtronic Neurovascular, Irvine, CA, USA). METHODS We retrospectively identified patients who underwent PED Flex treatment utilizing the Syphontrak at a single institution. The procedural data collected included parent artery tortuosity, patient demographics, aneurysm characteristics, other equipment utilized, and catheter-related complications. RESULTS A total of 47 consecutive aneurysm flow diversions were successfully performed using the Syphontrak. The patients' age ranged from 25 to 80 years (mean 57.3 ± 11.6) and 85% were women. The average aneurysm size was 4.8 ± 2.7 mm (range 2-14). All cases were in the anterior circulation, with 6 (12%) aneurysms located beyond the internal carotid artery termination. Significant cervical carotid tortuosity was present in 23% (11/47) of the cases and moderate-to-severe cavernous tortuosity (cavernous grade ≥2) in 51% (24/47) of the cases. The mean fluoroscopy time was 36.6 ± 14.8 min. In 12/47 cases (26%), vasospasm prophylaxis with intra-arterial verapamil infusion was performed. The Syphontrak was tracked to the intended distal position in all cases, with a 100% technical success of PED Flex implantation. Forty-six (98%) of the 47 patients were discharged home after an average length of stay of 1.38 days. No iatrogenic catheter-related vessel injury occurred. Transient, minor neurological morbidity occurred in 3 cases (6%) and 1 patient had a minor ischemic event (NIHSS score < 4) in the periprocedural period. CONCLUSION The Syphontrak is a new large-bore, multi-durometer intermediate catheter (IC) designed for use in modern neurointerventional procedures. We have shown its utility in 47 successful cases of PED Flex flow diversion of a wide range of complexity. The IC provides robust and atraumatic distal intracranial access while also providing an enhanced image quality with its large 0.060″ inner diameter.

中文翻译：

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使用新型大口径颅内中间导管的 47 例连续的管道柔性导流案例：Syphontrak 的细微差别和机构经验。

背景技术随着现代神经介入的复杂性不断增加，需要将颅内通路技术转向更强大的远端支撑平台。在这里，我们展示了我们在三轴平台上使用 Syphontrak 支持导管（Codman Neuro，Raynham，MA，USA）的经验，用于植入第二代 Pipeline Flex 栓塞装置（PED Flex；Medtronic Neurovascular，Irvine，CA，USA）。方法 我们回顾性地确定了在单一机构使用 Syphontrak 接受 PED Flex 治疗的患者。收集的程序数据包括父动脉曲折度、患者人口统计数据、动脉瘤特征、使用的其他设备和导管相关并发症。结果 使用 Syphontrak 成功完成了总共 47 次连续的动脉瘤分流。患者的年龄范围为 25 至 80 岁（平均 57.3 ± 11.6），85% 为女性。平均动脉瘤大小为 4.8 ± 2.7 mm（范围 2-14）。所有病例均位于前循环，其中 6 个（12%）动脉瘤位于颈内动脉末端之外。23% (11/47) 的病例出现明显的颈动脉迂曲，51% (24/47) 的病例出现中度至重度海绵状血管迂曲（海绵体分级≥2）。平均透视时间为 36.6 ± 14.8 分钟。在 12/47 例 (26%) 中，通过动脉内输注维拉帕米来预防血管痉挛。在所有情况下，Syphontrak 都被追踪到了预期的远端位置，PED Flex 植入技术取得了 100% 的成功。47 名患者中有 46 名 (98%) 在平均住院时间为 1.38 天后出院回家。未发生医源性导管相关血管损伤。3 例（6%）发生短暂的轻微神经系统疾病，1 例患者在围手术期发生轻微缺血事件（NIHSS 评分 < 4）。结论 Syphontrak 是一种新型大口径、多硬度的中间导管 (IC)，设计用于现代神经介入手术。我们已经在 47 个成功的 PED Flex 导流案例中展示了它的实用性，这些案例具有广泛的复杂性。IC 提供坚固且无创伤的远端颅内通路，同时还通过其 0.060 英寸的大内径提供增强的图像质量。多硬度中间导管 (IC) 设计用于现代神经介入手术。我们已经在 47 个成功的 PED Flex 导流案例中展示了它的实用性，这些案例具有广泛的复杂性。IC 提供坚固且无创伤的远端颅内通路，同时还通过其 0.060 英寸的大内径提供增强的图像质量。多硬度中间导管 (IC) 设计用于现代神经介入手术。我们已经在 47 个成功的 PED Flex 导流案例中展示了它的实用性，这些案例具有广泛的复杂性。IC 提供坚固且无创伤的远端颅内通路，同时还通过其 0.060 英寸的大内径提供增强的图像质量。