After introducing a range of twin marker braided microcatheters that perform well, Micrus introduce a trully innovative deflectable tip microcatheter.
We have had steerable guiding catheters previously that worked with a cumbersome “joystick” that was attached to control wires but these were short and never really found a big market. The Courier Enzo is a microcatheter with two microcontrol wires in its wall that are controlled by a small knob at the catheter hub. Though of slightly large O.D. than a non-deflectable catheter the low profile of the microcatheter has been preserved and devices with lumen of .017 and .019 are available.
The catheter tip can be deflected in two directios by rotating the knob with deflection in the order of 80 degrees in one direction and 70 degrees in the opposite. Whilst aiding navigation to distal sites by working with the catheter over a guidewire the greatest benefit will probably lie with the ability to selectively deliver microcoils within an aneurysm sac. Conventional catheters can lead to heavy packing lying eccentrically within the sac whist leaving other areas less densely filled despite complex coil geometry. By deflecting the catheter tip during or between coil deployments compartmentalistion of the sac can be minimised.
The Deal Breakers:
Does it work?------Well yes the tip can be seen to deflect when deployed in a vessel.
Is this useful? ------Well yes particularly when tackling a large sac .
What are the downsides? --- Well it is a little less flexible and certainly stiffer when in the deflected condition (though this may aid stability), if the catheter is not “relaxed” into the neutral position before removal from the packed aneurysm sac it could hook out deployed coils --- theoretically.
How much does is cost? --- More than the conventional catheters but not by much, in the order of 10%
If you contemplate a complex navigation have an Enzo on the shelf if not in the garage.
No conflict declared.
Dr A D Platts MB BS FRCS FRCR
Consultant Neuro and Vascular Radiologist
Royal Free Hospital NHS Trust
London NW3 2QG 0207 8302013
Andrew.Platts@royalfree.nhs.uk
