Wide-Neck and Bifurcation Aneurysms

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

“…Due to the influence of hemodynamics, wide-necked and bifurcation IAs incidence rate accounts for more than half of the total IAs, and is easy to rupture, accounting for about 60% of the ruptured aneurysms ( Barak et al, 2021 ; Claassen and Park, 2022 ; Philip et al, 2022 ). Traditional endovascular treatment for wide-necked and bifurcation IAs mainly relies on coil embolization, but the effect of simple embolization treatment for them is not ideal, often requiring assistance such as balloons and stents ( Webb et al, 2022 ). Moreover, when only a single device is used to assist in the embolization of bifurcation IAs, the coil state is not stable, and is prone to move to the parent artery, leading to treatment failure ( Kuwajima et al, 2022 ; Webb et al, 2022 ).…”

“…Traditional endovascular treatment for wide-necked and bifurcation IAs mainly relies on coil embolization, but the effect of simple embolization treatment for them is not ideal, often requiring assistance such as balloons and stents ( Webb et al, 2022 ). Moreover, when only a single device is used to assist in the embolization of bifurcation IAs, the coil state is not stable, and is prone to move to the parent artery, leading to treatment failure ( Kuwajima et al, 2022 ; Webb et al, 2022 ). Therefore, multiple stents or balloons are commonly used in combination to treat bifurcation IAs ( Kuwajima et al, 2022 ) Although such a strategy can effectively treat bifurcation IAs due to the high occupancy of multiple devices in the host artery, it is easy to cause ischemic complications.…”

“…We included research articles on the treatment of IAs patients aged ≥ 18 years with Comaneci/Cascade devices. Exclude articles based on the following reasons: ( Barak et al, 2021 ) non-English articles; ( Claassen and Park, 2022 ) Case report; ( Philip et al, 2022 ) Less than 5 cases in the case series; ( Philip et al, 2022 ) Review or editorial articles; ( Webb et al, 2022 ) In vitro or animal research; ( Wang et al, 2016 ) Combining the use of other instruments to assist in embolization of aneurysms, such as balloons and stents ( Kuwajima et al, 2022 ). Other unrelated articles.…”

“…Based on the special hemodynamic state of the bifurcation site of intracranial arteries, aneurysms are prone to form there ( Philip et al, 2022 ). Because it is difficult to treat wide-necked IAs or bifurcation IAs with multiple lateral branches, they have always been considered the Achilles’ heel of endovascular treatment ( Webb et al, 2022 ). Stents and balloons have been widely used for embolization treatment of wide-necked IAs, but they are not perfect.…”