Comaneci-Assisted Coiling of Wide-Necked Intracranial Aneurysm: A Single-Center Preliminary Experience

Abstract

Background: Wide-necked aneurysms remain challenging for both coiling and microsurgical clipping. They often require additional techniques to prevent coil prolapse into the parent artery, such as balloon- and stent-assisted coiling. Comaneci is an expandable and removable stent that acts as a bridging device and does not interfere with the blood flow of the parent artery. Methods: We retrospectively reviewed our institutional radiological and clinical chart of patients treated for saccular intracranial aneurysm via endovascular Comaneci-assisted coiling. The aim of the study was to report our preliminary experience in Comaneci-assisted coiling of wide-necked intracranial aneurysms. Results: We included 14 patients in the study. Of these, 11 had a ruptured intracranial aneurysm and were treated with Comaneci-assisted coiling. We registered five minor intraprocedural complications and two intraprocedural failures of the device. At one-year follow-up, a satisfying aneurysm occlusion was observed in 85% of the cases. Conclusion: Though long-term follow-up data and larger case series are needed, this preliminary study showed the feasibility of the Comaneci-assisted coiling method for both ruptured and unruptured wide-neck intracranial aneurysms, with similar occlusion rates as balloon-assisted coiling. However, we registered high incidence of thromboembolic complications; these were probably related to the lack of heparin administration. The main advantageous application of this technique is likely in cases of ruptured intracranial aneurysms, as there is no need for post-procedural antiplatelet therapy.

A systematic review and meta-analysis of Comaneci/Cascade temporary neck bridging devices for the treatment of intracranial aneurysms

“…Among the 11 records that obtained the full text, one was excluded due to data overlap, and one was excluded due to limited information (only an abstract). Therefore, in the final quantitative analysis, we included a total of nine records ( Sirakov et al, 2018 ; Fischer et al, 2020 ; Molina-Nuevo et al, 2020 ; Sirakov S. et al, 2020 ; Sirakov A. et al, 2020 ; Tomasello et al, 2020 ; Lim et al, 2021 ; Taqi et al, 2021 ; Vinacci et al, 2022 ). Please refer to Figure 1 for the specific screening process.…”

“…A third author resolved the disagreement. According to relevant studies, the angiographic outcome was evaluated based on Raymond Roy classification, and adequate occlusion was defined as Raymond Ray I + II ( Fischer et al, 2020 ; Vinacci et al, 2022 ). The technical success was defined as successful assistance of the device in the embolization of the aneurysm and covering the neck of the aneurysm, along with perfect removal of the device.…”

“…Vinacci et al (2022) Patients with unruptured aneurysms: DAPT with ASA 100 mg/d and clopidogrel 75 mg/d 5 days before the procedure. The DAPT was discontinued after the procedure if the Comaneci-assisted embolization was successful.…”

Endovascular Treatment of Wide-Neck Bifurcation Aneurysm: Recent Trends in Coil Embolization with Adjunctive Technique

“… 43) Appropriate antiplatelet therapy and intravenous heparin administration are important to prevent thrombus formation inside the mesh of the Comaneci. 44) Treatment options in combination with BAC or SAC may be selected for difficult-to-treat WNBAs.…”