COURIER

Enzo

microcatheters

A FAMILY OF INNOVATIVE CEREBROVASCULAR MICROCATHETERS

COURIER

C O N T R O L A N D D E L I V E R

Setting a New Standard

With its unique combination of deflectability and stability, COURIER Enzo sets a new standard for microcatheters. Dial-In Stability Enzos active tip deflection allows better control of the desired stability to reduce kickback during embolization. This can help in challenging cases with acute turns and small or densely packed aneurysms in which catheter access is tenuous.

The Enzo tip remained stable inside an acutely angled 4 mm supraclinoid ICA aneurysm throughout the procedure.

Pre-coiling

Post-coiling

Pack. REDIRECT. Pack. The ability to deflect Enzos tip during the procedure can facilitate the redirection of embolics, allowing more control over the positioning and packing of coils, especially in large or multilobular aneurysms. This could eliminate the need to remove, reshape, and reposition the cathetersaving valuable procedure time.

Pre-coiling

Upper lobe coiled

Lower lobe coiled

The Enzo tip was redirected to coil the upper and lower lobes progressively in a complex upper basilar aneurysm.

1.8 F Distal OD: Helps navigate through stent cells.

Two Radiopaque Markers: Platinum radiopaque markers, 3 cm apart, enhance fluoroscopic visibility of the catheter tip.

Flexible and Stable Distal Shaft Segment: Micrus proprietary design and fabrication techniques result in superior tip shape retention and stability* to reduce kickback.

Exceptional Trackability. Preferred Outcomes.

COURIER Microcatheters feature the most pushable proximal shaft* a flexible distal , segment, and a patented hydrophilic coating that ensure excellent trackability to help you get thereand provide excellent stability within the lesion to help you stay there.

Shaft Construction: Multilayer shaft construction creates smooth transition zonesfrom a soft, lowprofile distal segment with enhanced resistance to ovalization to a supportive proximal end.

COURIER helped treat a giant 3 cm pericallosal artery aneurysm. It held a J-curve shape and was stable through a high degree of tortuosity.

90 cm Shaft Marker: Allows for expedited microcatheter insertion into a guiding catheter for reduced fluoroscopic use.

Proximal Shaft: Multiple slender stainless-steel ribbons crisscross to form a dense proximal braided section, providing better catheter pushability and control.*

The Revolutionary COURIER

Enzo

Microcatheter

Ergonomic Deflection Knob: Allows in vivo control of Enzos tip, deflectable up to 90 degrees (from straight) in opposing directions.

Visionary Innovation. Unmatched Performance.

COURIER Enzo brings a whole new level of functionality to neurovascular microcatheters. The secret lies in the unique actively deflectable tip that allows in vivo control of the tip shape via Enzos ergonomic hub. COURIER Enzos tip can be deflected up to 90 degrees (from straight) in opposing directions. This permits a greater level of control over catheter and embolic placement.

In this 4 mm posterior communicating artery aneurysm case, notice how sharply Enzo deflected into the large neck. It managed to steadily hold this tenuous access point throughout the treatment. Later, Enzo aided coiling, deflecting away from the dome.

COURIER Straight and Preshaped Microcatheters

Shape It. Get There. Stay There.
The unique design of COURIER Microcatheters delivers the ideal balance of form and function. The result is a rich set of features and an optimal blend of access and support that are particularly suited for distal accessbecause getting there is only half the challenge.

Endurance Technology Beyond Just Shape Retention

COURIER features our exclusive Endurance Technology, integrating all layers of the microcatheter into a well-balanced laminate. The result is amazing shapability and retention of the tip shape during even the most complex, lengthy procedures.

Shapability COURIERs superior shapability* allows you to match the anatomy one to one, reducing the need to overshape.
25

All microcatheters were shaped to 90 degrees. Starting shape is shown after mandrel was removed.
90 89
Initial Shape (Degrees)

19 8

81 70 45 64

Increasing Initial Shape Loss

COURIER 170

Product A

Product B

Product C

Shape Retention COURIER retained over 90% of its initial tip shape after 3 hours of simulated use* .
Additional Shape Loss Over 3 Hours
90

Shape Retention (Degrees)

75

60

45

30 0 0.5 1 1.5 2 Time (Hours) 2.5 3

COURIER 170

Product A

Product B

Product C

COURIER shape retention provides better shape stability inside the lesion.

*Data on file, Micrus Endovascular Corporation.

CATALOG NUMBER

DESCRIPTION

PROXIMAL /DISTAL ID

170 190

TOTAL / USABLE LENGTH

160 cm / 150 cm

PROXIMAL OD/ LOW-PROFILE DISTAL OD

3.0 F (1.0 mm) / 2.9 F (.97 mm)

MSH170000-00

Deflectable

.0170 / .0170

Compatible with embolics including Micrus 10, 14, and 18 System Microcoils*

CATALOG NUMBER

DESCRIPTION

PROXIMAL /DISTAL ID

TOTAL / USABLE LENGTH

160 cm / 150 cm

PROXIMAL OD/ LOW-PROFILE DISTAL OD

3.1 F (1.03 mm) / 3.0 F (1.0 mm)

MSH190000-00

Deflectable

.0190 / .0190

Compatible with embolics including Micrus 14 and 18 System Microcoils*

CATALOG NUMBER

DESCRIPTION

PROXIMAL /DISTAL ID

170

TOTAL / USABLE LENGTH

156 cm / 150 cm 156 cm / 150 cm 156 cm / 150 cm

PROXIMAL OD / LOW-PROFILE DISTAL OD

2.3 F (.76 mm) / 1.8 F (.59 mm) 2.3 F (.76 mm) / 1.8 F (.59 mm) 2.3 F (.76 mm) / 1.8 F (.59 mm)

MST170000-00 MPS170045-00 MPS170090-00

Straight 45 90

.0170 / .0170 .0170 / .0170 .0170 / .0170

Compatible with embolics including Micrus 10, 14, and 18 System Microcoils*

CATALOG NUMBER

DESCRIPTION

PROXIMAL /DISTAL ID

190

TOTAL / USABLE LENGTH

156 cm / 150 cm 156 cm / 150 cm 156 cm / 150 cm

PROXIMAL OD/ LOW-PROFILE DISTAL OD

2.4 F (.79 mm) / 1.9 F (.63 mm) 2.4 F (.79 mm) / 1.9 F (.63 mm) 2.4 F (.79 mm) / 1.9 F (.63 mm)

MST190000-00 MPS190045-00 MPS190090-00

Straight 45 90

.0190 / .0190 .0190 / .0190 .0190 / .0190

Compatible with embolics including Micrus 14 and 18 System Microcoils* Minimum guiding catheter ID: COURIER 170 Microcatheters: .035 / .889 mm COURIER 190 Microcatheters: .042 / 1.067 mm COURIER Enzo Microcatheters: .050 / 1.27 mm Hydrophilic coated length (distal to proximal): 100 cm Recommended guidewire diameter: .014
* Please refer to the appropriate Instructions for Use for compatibility information.

821 Fox Lane San Jose, CA 95131 United States T 408.433.1400 F 408.433.1401

Avenue des Baumettes 7 1020 Renens Switzerland T +41.21.631.3434 F +41.21.631.3444

1st Floor, Unit 4 Stansted Courtyard Takeley Bishops Stortford Essex CM22 6PU United Kingdom T +44.800.612.6363 F +44.800.612.8484

CAUTION: Federal (U.S.A.) law restricts this device to sale by or on the order of a physician. MICRUS, COURIER, and the M logo are registered trademarks of Micrus Endovascular Corporation. Enzo and Endurance Technology are trademarks of Micrus Endovascular Corporation. Other product names or marks are the property of their respective owners. 2007 Micrus Endovascular Corporation. All rights reserved.

P/N 50885-01 REV A

Courier EnzoTM Increases Packing Density

The Courier Enzo deflectable tip microcatheter can distribute coils within an aneurysm to achieve improved packing density. 3 INRs evaluated its performance in an in-vitro study under angiography. 10 silicone aneurysms, each 10mm in diameter, were coiled using Courier Enzo and a conventional competitive microcatheter (Product A). The end point was when the microcatheter was kicked out of the aneurysm. Enzo showed a statistically significant 9% increase in packing density as compared to Product A. Micrus Cerecyte Microcoils were used in both arms. Enzo consistently demonstrated higher packing density.

Packing density with Enzo and Product A

5O%

4O%

3O%

2O%

39.1% 0.9%

29.6% 7.4%

1O%

O%

ENZO

Product A

* Study performed at Stanford University Medical Center. Data on file, Micrus Endovascular Corporation * Presidio, Helipaq, Ultipaq and Cashmere Microcoils were used during the study

Courier Enzo allows better control of the microcatheter tip. This helps direct the coils and find empty spaces within the interstices of the coil mass, especially during the final stages of coiling.*

Redirecting Enzos tip resists catheter kickback

The Courier Enzo is designed to deflect. It provides stability by resisting being kicked out of the lesion. This can provide consistently higher packing density.

Better stability provides higher packing density

* Please refer to IFU for proper handling instructions.

Packing Density Can Affect Re-treatment Rates

Non-procedural re-rupture from the index aneurysm by degree of occlusion*

The CARAT study reported that the degree of aneurysm occlusion after the initial treatment is a strong predictor of the risk of subsequent rupture in patients presenting with subarachnoid hemorrhage, which justifies attempts to completely occlude aneurysms.1

Coiling
n Overall Degree of Occlusion Complete (100%) Small residual neck (91%-99%) Residual neck (70%-90%) Partial (<70%) 114 128 41 12 358 363 46 20 2 (1.8) 3 (2.3) 2 (4.9) 3 (25.0) 0.6 0.8 4.3 15.0 295 PersonYears 788 Hemorrhages, Rate/100 n (%) Person-Years 10 (3.4) 1.3 <0.0001 P

* Based on Kaplan-Meier analysis and the log-rank test with censoring at time of rupture, retreatment, or loss to follow-up.

Comparison between angiographic evaluation and embolized volume during long-term follow-up Embolized Volume (%)
Stable 30.8 10.2* (n = 44) 27.5 12.1 (n = 18) 20.5 4.8 (n = 10) Unstable 19.9 0.6 (n = 5) 13.7 6.0 (n = 11) 15.4 8.2 (n = 12)

Initial Angiographic Results of Treatment

Total (n = 49) Subtotal (n = 29) Partial (n = 22)
* P = .03. P = .0001.
REFERENCES:

There is a significant correlation between embolized volume and stability of embolized aneurysms. Embolized volume is a more objective index than is subjectively angiographic percentage occlusion.2

1. S. Claiborne Johnston, MD, PhD et al. Predictors of Rehemorrhage After Treatment of Ruptured Intracranial Aneurysms The Cerebral Aneurysm Rerupture After Treatment (CARAT) Study. 10.1161/STROKEAHA.107.495747 2. Shinichi Tamatani et al. Evaluation of the Stability of Aneurysms after Embolization Using Detachable Coils: Correlation between Stability of Aneurysms and Embolized Volume of Aneurysms. AJNR Am J Neuroradiol 23:762767, May 2002

www.micruscorp.com
CAUTION: Federal (U.S.A.) law restricts this device to sale by or on the order of a physician. MICRUS, the M logo, Courier and Cerecyte are registered trademarks of Micrus Endovascular Corporation. Enzo is a registered trademark of Micrus Endovascular Corporation. 2008 Micrus Endovascular Corporation. All rights reserved.

P/N 51040-02 Rev A