Guide catheter access: Basics and solutions to difficult anatomy

Guide catheter access is a critical first step to an endovascular procedure. This chapter reviews common access sites and catheter selections for typical endovascular cases. The principles to selecting guide constructs should address how distal is the lesion? How tortuous is the route? What is the size of the vessels being accessed? How many devices are required to treat the lesion? In the current era, noninvasive imaging is ubiquitous and will provide the neurointerventional practitioner with an excellent understanding of the route being taken to the lesion; therefore, allowing selection of the proper catheter construct.