Comaneci device-assisted embolization of wide-necked carotid aneurysms with an unfavorable ratio

Abstract

Background Endovascular treatment is the technique of choice for most intracranial aneurysms. However, the treatment of morphologically complex wide-necked aneurysms with an unfavorable anatomy is still a therapeutic challenge. The purpose of the study is to describe the initial experience with the Comaneci embolization assist device for the treatment of wide-necked aneurysms with an unfavorable ratio for direct embolization. Methods We report a retrospective single-center analysis taken from a prospective database of consecutive aneurysms of the anterior circulation treated using the Comaneci device in the period from March 2017 to March 2019. Results Eighteen aneurysms were collected from 16 patients (9 women and 7 men) treated using the Comaneci device. The mean age was 48.4 years (range 36–81). Twelve patients had SAH, three were incidental aneurysms and one had compressive symptoms. A complete asymptomatic occlusion rate of 88.8% was obtained. The major complication rate was 5.55%. Conclusion The Comaneci embolization assist device is a safe, effective option for endovascular treatment of complex aneurysms with an unfavorable ratio.

Coil embolization of a complex renal artery aneurysm using a new scaffold (Comaneci) device – A case report

“…[4,5,7] Variations of the technique including stent-assisted coiling and balloonassisted coiling were developed in attempts to overcome some of these barriers and have been shown to be effective in management of aneurysms with an unfavorable ratio. [5,10] However, these techniques are not without limitations. BAC halts forward blood flow compromising end-organ perfusion and can also cause vessel damage increasing risk of thromboembolic events or aneurysm rupture.…”

“…[ 4 , 5 , 7 ] Variations of the technique including stent-assisted coiling and balloon-assisted coiling were developed in attempts to overcome some of these barriers and have been shown to be effective in management of aneurysms with an unfavorable ratio. [ 5 , 10 ]…”

“…BAC halts forward blood flow compromising end-organ perfusion and can also cause vessel damage increasing risk of thromboembolic events or aneurysm rupture. [ 10 , 11 ] SAC mitigates the disruption in distal perfusion encountered with BAC but commits the patient to long-term dual-antiplatelet therapy after the procedure which is not always feasible. [ 10 ] There is also the risk of stent fracture and occlusion over time.…”

“…[ 10 , 11 ] SAC mitigates the disruption in distal perfusion encountered with BAC but commits the patient to long-term dual-antiplatelet therapy after the procedure which is not always feasible. [ 10 ] There is also the risk of stent fracture and occlusion over time. In addition, these techniques are not ideal for cases in which preservation of one or more segmental vessels arising from the aneurysm sac is desired, as in the present case.…”

Surgical Clipping Versus Endovascular Coiling in the Management of Intracranial Aneurysms

“…The Comaneci device (Rapid Medical, Yokneam, Israel), introduced to the US in 2019, is a retrievable stent that can be used along with coiling for better occlusion of wide-necked aneurysms without limiting blood flow [ 76 ]. Molina-Nuevo et al concluded that the Comaneci device is a safe adjunctive treatment option for wide-necked aneurysms, with a complete occlusion rate of 88.8% and a major complication rate of 5.6% among 16 patients [ 77 ].…”