Early experience with a temporary bridging device (Comaneci) in the endovascular treatment of ruptured wide neck aneurysms

Sirakov, Stanimir; Sirakov, Alexander; Hristov, Hristo; Minkin, Krasimir; Penkov, Marin; Karakostov, Vasil

doi:10.1136/neurintsurg-2017-013641

Cited by 30 publications

(20 citation statements)

References 19 publications

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“…However, no device-related complications were recorded in our initial and early experience with this new temporary bridging device. 9 This is valid also for this particular case.…”

Section: Discussionsupporting

confidence: 52%

Coiling of ruptured, wide-necked basilar tip aneurysm using double Comaneci technique

Sirakov

Hristov

et al. 2018

BMJ Case Reports

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In this report, we present a novel technique of successful coil embolisation using temporary deployment of two Comaneci devices placed in Y configuration across a wide-neck ruptured basilar tip aneurysm. The placement of two devices across the wide aneurysm neck allowed optimal coverage for safe coil delivery, while maintaining parent vessel patency. This case highlights the unique and safe applicability of two crossed Comaneci devices in a ruptured aneurysm with unfavourable anatomy, ultimately resulting in complete aneurysm obliteration. To our knowledge, this is the first reported case of double Comaneci usage in a wide-neck ruptured aneurysm. This technique can be potentially applied in challenging wide-neck bifurcation aneurysms, particularly when double antiplatelet therapy is of concern.

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“…However, no device-related complications were recorded in our initial and early experience with this new temporary bridging device. 9 This is valid also for this particular case.…”

Section: Discussionsupporting

confidence: 52%

Coiling of ruptured, wide-necked basilar tip aneurysm using double Comaneci technique

Sirakov

Hristov

et al. 2018

BMJ Case Reports

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“…It is important to emphasize that these observations are based only on personal opinion and do not represent statistically validated conclusions. As noted during the initial experience with Comaneci, deflection of the device (and particularly its distal tip) can produce significant nearly occlusive spasm during expansion 8. We did not observe this phenomenon in the present case series with the Cascade.…”

Section: Discussioncontrasting

confidence: 38%

“…One such method is the placement of a temporal neck bridging device, which allows parent vessel flow during intrasaccular embolization 6. Recent clinical experience with the Comaneci temporal neck bridging device demonstrated that this methodology can result in satisfactory and durable embolization 8…”

Section: Discussionmentioning

confidence: 99%

“…However, the inevitable occlusion of the parent vessel associated with this technique, poses risks of ischemic complications due to compromised downstream perfusion, blockage of perforators, and thrombus formation during the balloon inflation 4 5. The application of devices offering temporal neck bridging, while maintaining parent vessel patency during coil embolization, has recently emerged as a new and attractive alternative to placement of occlusive balloons 6–8. Here, we describe our initial experience with the recently introduced Cascade non-occlusive neck bridging device in the treatment of ruptured wide-neck intracranial aneurysms.…”

Section: Introductionmentioning

confidence: 99%

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Early clinical experience with Cascade: a novel temporary neck bridging device for embolization of intracranial aneurysms

Sirakov

Minkin

et al. 2019

J NeuroIntervent Surg

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BackgroundTemporary placement of a retrievable neck bridging device, allowing parent vessel flow, is an attractive alternative to balloon remodeling for treatment of ruptured intracranial aneurysms.ObjectiveTo present, in a single-center study, our initial experience with Cascade (Perflow, Israel) in the treatment of ruptured intracranial aneurysms.MethodsDuring a period of 1.5 months, 12 patients with aneurysmal subarachnoid hemorrhage underwent coil embolization in conjunction with Cascade in our center. Retrospective analysis of prospectively collected angiographic and clinical data was conducted to assess the safety and efficacy of the device.ResultsAmong all treated patients, 41.7% (5/12) were female, the median age was 55 (47–77) years, the median aneurysm dome size was 5.75 mm (3–9.1), and the median neck size was 3.55 mm (2.3–7.9). Complete obliteration (Raymond 1) was achieved in 75% (9/12) of cases, and intentional residual neck (Raymond 2) was left in three cases (25%). None of the patients received any oral or intravenous antiplatelet therapy perioperatively. No thromboembolic complications, device-related spasm, vessel perforation, or coil entanglement were detected in any of the treated patients.ConclusionsIn our initial experience, treatment of wide-neck ruptured intracranial aneurysms with Cascade is safe and effective, without the need for adjuvant antiplatelet therapy. Long-term follow-up data in larger cohorts are needed to confirm these preliminary findings.

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“…The Comaneci device comes in three different sizes: (1) Comaneci is 32 mm in net length and expands to 4.5 mm in diameter; (2) Comaneci Petit is 24 mm in net length and expands to 3.5 mm; and (3) Comaneci 17 is 22 mm in net length and expands to 3.0 mm 35. Sirakov et al 36 2018 described their experience with Comaneci in treating ruptured wide-neck aneurysms. Complete occlusion was achieved in 86% (25/29) of the patients, and only one patient had possibly procedure-related complications, thus supporting the use of Comaneci in treating ruptured aneurysms.…”

Section: Advances In Stent-assisted Coilingmentioning

confidence: 99%

Advances in endovascular aneurysm management: coiling and adjunctive devices

et al. 2020

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Endovascular coil embolisation continues to evolve and remains a valid modality in managing ruptured and unruptured cerebral aneurysms. Technological advances in coil properties, adjunctive devices and interventional techniques continue to improve long-term aneurysm occlusion rates. This review elaborates on the latest advances in next-generation endovascular coils and adjunctive coiling techniques for treating cerebral aneurysms.on June 9, 2020 by guest. Protected by copyright.

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Early experience with a temporary bridging device (Comaneci) in the endovascular treatment of ruptured wide neck aneurysms

Abstract: The Comaneci device offers a new promising and reliable technique that can safely support aneurysm coiling occlusion even in a rupture environment. However, long term monitoring of patients treated by this device is mandatory.

Cited by 30 publications

References 19 publications

Coiling of ruptured, wide-necked basilar tip aneurysm using double Comaneci technique

Coiling of ruptured, wide-necked basilar tip aneurysm using double Comaneci technique

Early clinical experience with Cascade: a novel temporary neck bridging device for embolization of intracranial aneurysms

Advances in endovascular aneurysm management: coiling and adjunctive devices

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