Mechanical Comaneci 17-stent angioplasty for a sub-optimally deployed flow-diverter stent

Abstract

Flow diverter stents are increasingly used as the sole endovascular treatment method for complex or wide-necked intracranial aneurysms. 1 Technical complications related to stent deployment are infrequently reported in the literature. During treatment, implant misbehaviors may occur, including incomplete tubular expansion with insufficient aneurysmal coverage and wall apposition, proximal or distal narrowing, and twisting along the axis. 2 – 4 Little is known about this phenomenon, especially if it relates to the operator experience, deployment techniques, different devices, and implant properties. The management of these complications requires technical precision and is often remediated by “massaging” the stent with the delivery system, balloon angioplasty, or placement of additional self-expandable stents. Lastly, if critically damaged, the stent could be taken out of the vessel with a combination of maneuvers called “stentectomy.” 5 These techniques often necessitate multiple navigations and the utilization of a larger microcatheter. We aim to highlight the feasibility of Comaneci 17 stent-angioplasty as an effective bailout strategy for inadequately deployed flow diverter stents. The suggested approach's technical aspects, including pros and cons, have been discussed.

Innovations in intracranial aneurysm treatment: a pilot study on the Choydar flow diverter

“…After full deployment, stent apposition is meticulously verified using multiple-position angiography, dual-volume imaging, or Dyna CT. In cases of malapposition, corrective measures such as microcatheter manipulation ( 7 ) or appropriate balloon dilatation can be employed. Throughout the procedure, the system’s tension is managed to avoid excessive force, ensuring a smooth and precise deployment.…”