VASCULAR BIOLOGY Original Studies A Novel Guide Catheter Enabling Intracranial Placement Michael C. Hurley, 1,2 MD, Arun K. Sherma, 2 MD, Daniel Surdell, 1,2 MD, Ali Shaibani, 1,2 MD, and Bernard R. Bendok, 1,2 * MD We describe use of a novel guide, catheter with a soft and pliable, 6-cm or 12-cm dis- tal segment that enables distal, including intracranial, placement—the Neuron guide catheter (Penumbra, San Leandro, CA)—in the treatment of 11 cases with a range of neuroendovascular lesions. We were able to advance the Neuron guide catheter to the intended level in each case and suffered no complications related to catheter spasm, dissection, thrombosis or thromboembolism. V C 2009 Wiley-Liss, Inc. Key words: aneurysm; vascular anatomy; stenting; access; endovascular INTRODUCTION Neuroendovascular interventions require adequate sheath and guide-catheter placement. We report the use of a novel guide-catheter, the Neuron guide-catheter (Penumbra, San Leandro, CA) placed at or above the skull-base, in a range of intracranial procedures. METHODS With IRB approval, we reviewed the notes and images of 10 consecutive patients undergoing neuro- interventions utilizing the Neuron guide-catheter between December, 2007 and March, 2008. We recorded demographics, procedure type and indication, success of guide-placement, type of microcatheter/devices navigated through the guide catheter and complications. TECHNIQUE Patients undergo initial angiography with a 4 F or 5 Fr-diagnostic catheter and short 5 Fr sheath. Guide- catheters are chosen after angiographic definition of the lesion and vascular anatomy. IV heparin is admin- istered, diagnostic catheter and sheath exchanged over a Connors 0.035 00 exchange-wire for a 7 Fr sheath (of variable length), and the Neuron advanced over the Connors-wire to the mid-cervical target-vessel. After contrast injection through the Neuron excludes malpositioning, vessel spasm or dissection, a micro- catheter and microwire are navigated distally and can then be employed for coaxial advancement of the Neu- ron to a more distal location. The microcatheter is then advanced to its target to deliver a range of materials and devices depending on procedure type (Table I). At completion, intracranial, and cervical angiography through the Neuron checks for any thromboemboli, intimal injuries, or vasospasm. RESULTS Eleven patients (M:F 1.2:1; mean age 62.6 yrs) underwent 11 procedures: 5 anterior-circulation, 5 pos- terior-circulation, and 1 middle meningeal. These com- prised 6 aneurysm coilings (2 stent assisted), 2 AVM, 1 Department of Radiology, The Feinberg School of Medicine and McGaw Medical Center, Northwestern University, Chi- cago, Illinois 60611 2 Department of Neurological Surgery, The Feinberg School of Medicine and McGaw Medical Center, Northwestern Univer- sity, Chicago, Illinois 60611 Conflict of interest: Nothing to report. *Correspondence to: Bernard R. Bendok, MD, . Department of Radi- ology and Neurological Surgery, The Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 2210, Chicago, IL 60611. E-mail: bbendok@nmff Received 5 May 2009; Revision accepted 6 May 2009 DOI 10.1002/ccd.22137 Published online 7 August 2009 in Wiley InterScience (www. interscience.wiley.com) V C 2009 Wiley-Liss, Inc. Catheterization and Cardiovascular Interventions 74:920–924 (2009)