Abstract 318: Its Not (just) Delivery : Multifunctionality of Carrier Delivery Catheter in Middle Meningeal Artery Embolization

Introduction Delivery catheters are increasingly utilized in neurointerventions to facilitate guide or aspiration catheter deliverability through tortuous anatomy. They are designed to have a tapered, hydrophilic coated, atraumatic tip to reduce the ledge effect while advancing large bore guide catheters with the additional benefit of advancement without a guidewire. The Carrier Delivery Catheter (The Balt Group, Montmorency, France) has the added benefit of having a PTFE liner through the length of the catheter, which raises the possibility that they may have a multimodal role (particle/coil delivery, liquid embolics) in elective cases such as middle meningeal artery (MMA) embolization. Methods At our university‐based medical center, the Carrier Delivery Catheter was used in two patients undergoing bilateral MMA embolization for chronic subdural hematomas. Results The Carrier Delivery Catheter Small (OD 0.059”) was used in each procedure to deliver a 6F (0.070” and 0.071”) guide catheter up to the ostium of the MMA. This was achieved easily, without a guidewire, and without inducing vasospasm. Carrier was even able to advance over a guidewire into the MMA trunk (diameters 0.16cm, 0.16cm, 0.19cm and 0.18cm), with the tip nosing into the frontal and parietal branches of the MMA. Further, the Carrier Delivery Catheter was utilized to perform the embolizations. It was able to deliver two different types of coils. This included Embold Fibered Coils (2mm and 3mm diameter) and Tornado Coils (3‐2mm diameter), tris‐acryl gelatin microspheres, and the liquid embolic agent, n‐butyl‐cyanoacrylate (nBCA). Conclusion This is the first report of the Carrier Delivery Catheter being used as a multimodal catheter for MMA embolizations. It was used to deliver guide catheters and embolic agents in an easy and repeatable fashion without vasospasm. While it accommodates the use of a guidewire, it is not always necessary. In our very limited experience, this novel technique appeared safe and effective for use in accessing and embolizing the MMA and its branches, although additional studies should be performed to support our findings.