Biaxial system using the Benchmark intracranial guide catheter for placement of a Pipeline Embolization Device for intracranial aneurysms.

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. CONCLUSION: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.