Stent-assisted coiling and balloon-assisted coiling in the management of intracranial aneurysms: A systematic review &amp; meta-analysis

BackgroundEndovascular treatment of wide-necked aneurysms remains challenging without the use of adjunctive devices to preserve the parent artery.ObjectiveTo present our initial experience with a temporary bridging device, the Comaneci (Rapid Medical, Israel). The compliant remodeling mesh protects the parent artery during coil occlusion without flow arrest in the distal vasculature. Permanent dual antiplatelet therapy is not required since the device is fully removed at the end of the procedure.MethodsAll intracranial aneurysms treated by coil occlusion with the Comaneci device between December 2014 and November 2015 were included. Angiographic and clinical results were retrospectively analysed, including follow-up examinations. All aneurysms were unruptured.Results18 aneurysms of the internal carotid artery were included. Successful coil occlusion assisted by the Comaneci device as intended was possible in 14 cases (77.8%). Insufficient coverage of the aneurysmal neck was observed in four cases (22.2%), with modification of the treatment to stent-assisted coiling or remodeling. One clinically relevant complication occurred (5.6%).ConclusionsOur initial experience shows that use of the Comaneci device is straightforward for the treatment of selected wide-necked aneurysms. Further studies with long-term follow-up data are needed to identify the significance of the presented technique in the neurointerventional armamentarium.

Section: Discussionmentioning

confidence: 98%

Coiling of wide-necked carotid artery aneurysms assisted by a temporary bridging device (Comaneci): preliminary experience

Fischer

Weber

Carolus

et al. 2016

“…Wang et al 25 performed a meta-analysis comparing BAC and SAC in intracranial aneurysms. SAC achieved a better complete occlusion rate of aneurysms at 6 months or later after the procedure, with comparable intraprocedural complication and retreatment rates.…”

Section: Discussionmentioning

confidence: 99%

Stent assisted coiling versus non-stent assisted coiling for the management of ruptured intracranial aneurysms: a meta-analysis and systematic review

Zhang

Zuo

Tang

et al. 2019

PurposeTo compare the safety and efficiency of stent assisted coiling (SAC) with non-SAC for the management of ruptured intracranial aneurysms.MethodsA meta-analysis that compared SAC with coiling alone and balloon assisted coiling was conducted by database searching. The primary outcomes of this study were immediate occlusion and progressive thrombosis rate, overall perioperative complication rate, and angiographic recurrence. Secondary outcomes included mortality at discharge, hemorrhagic and ischemic complications, and favorable clinical outcome at discharge and at follow-up.ResultsEight retrospective cohort studies with 1408 ruptured intracranial aneurysms (SAC=499; non-SAC=909) were included. The SAC group tended to show a lower immediate complete occlusion rate than the non-SAC group (54.3% vs 64.2%; RR 0.90; 95% CI 0.83 to 0.99; I2=17.4%) and achieved a significantly higher progressive complete rate at follow-up (73.4% vs 61.0%; RR 1.30; 95% CI 1.16 to 1.46; I2=40.5%) and a lower recurrence rate (4.8% vs 16.6%; RR 0.28; 95% CI 0.16 to 0.50; I2=0.0%). With respect to safety concerns, overall perioperative complications in the SAC group were significantly higher (20.2% vs 13.1%; RR 1.70; 95% CI 1.36 to 2.11; I2=0.0%). However, no significant difference was found for mortality rate at discharge (6.3% vs 6.2%; RR 1.29; 95% CI 0.86 to 1.94; I2=0.0%), or favorable clinical outcome rate at discharge (73.4% vs 74.2%; RR 0.95; 95% CI 0.88 to 1.02; I2=12.1%) and at follow-up (85.6% vs 87.9%; RR 0.98; 95% CI 0.93 to 1.02; I2=0.0%; P=0.338).ConclusionsSAC has a lower recurrence rate than non-SAC. Nevertheless, further validation by well designed prospective studies is warranted for determining whether stents improve angiographic outcome without an increased complication rate or unfavorable clinical outcome.

“…Balloon remodeling or BAC techniques involve the temporary inflation and placement of a balloon catheter across the neck of an aneurysm, allowing safe coil deployment and a stable three-dimensional coil structure to form in lesions with unfavorable neck to dome ratios. Many interventionalists prefer BAC over SAC for treatment of ruptured wide neck aneurysms, because with the balloon remodeling technique there is no need for an antiplatelet regimen 10. The Comaneci device can be used as a remodeling balloon, for temporary coverage of the aneurysm neck during coil insertion, without the drawback of blocked flow within the parent artery during expansion of the device.…”

Section: Discussionmentioning

confidence: 99%

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

Sirakov

Hristov

et al. 2018