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Ravina K, Finch IJ, Patel B, Yim B. Y-Stent Technique Using Dual Comaneci Embolization Assist Devices for Coil Embolization of a Ruptured Wide-Necked Anterior Communicating Artery Aneurysm: A Technical Case Report. Oper Neurosurg (Hagerstown) 2024; 27:365-369. [PMID: 38578712 DOI: 10.1227/ons.0000000000001143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/29/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND AND IMPORTANCE Despite technological advances, ruptured wide-necked aneurysms continue to pose a challenge for endovascular management. Comaneci (Rapid Medical) is a relatively new temporary aneurysm neck bridging device to assist in coiling of wide-necked aneurysms without the need for dual antiplatelet therapy or parent vessel flow interruption. Y configuration is often necessary to prevent coil migration in cases of wide-necked aneurysms. Thus far, there have been no reports of using Comaneci device in Y configuration to aid anterior circulation aneurysm treatment. CLINICAL PRESENTATION A 60-year-old man presented with a Hunt-Hess grade 5, modified Fisher grade 4 subarachnoid hemorrhage from a ruptured wide-necked anterior communicating artery aneurysm with a dome-to-neck ratio of 1:2. Two Comaneci devices were used in a Y configuration to prevent coil prolapse into the contralateral A2 branch. After successful coiling of the aneurysm, both Comaneci devices were collapsed and removed without incident; the coil catheter was also removed without incident. Follow-up angiogram demonstrated successful occlusion of the wide-necked anterior communicating artery aneurysm without the use of a permanent stent or balloon assistance. CONCLUSION This case represents a first-time report of successfully using 2 Comaneci devices in a Y configuration for the treatment of a ruptured wide-necked anterior circulation aneurysm. This knowledge can potentially further expand the use of double Comaneci devices in Y configuration for the treatment of both anterior and posterior circulation aneurysms.
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Affiliation(s)
- Kristine Ravina
- Department of Neurosurgery, Carilion Clinic, Virginia Tech School of Medicine, Roanoke , Virginia , USA
| | - Ira J Finch
- Bay Imaging Consultants Medical Group, Walnut Creek , California , USA
| | - Biraj Patel
- Department of Neurosurgery, Carilion Clinic, Virginia Tech School of Medicine, Roanoke , Virginia , USA
| | - Benjamin Yim
- Neurosurgery Division, East Bay Brain and Spine Medical Group, Walnut Creek , California , USA
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Essibayi MA, Srinivasan VM, Madriñán-Navia HJ, Park MT, Scherschinski L, Catapano JS, Rhodenhiser EG, Graffeo CS, Ducruet AF, Albuquerque FC, Lawton MT. Management of basilar fenestration aneurysms: a systematic review with an illustrative case report. J Neurointerv Surg 2023; 16:24-30. [PMID: 36564200 DOI: 10.1136/jnis-2022-019728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Basilar artery (BA) fenestration aneurysm (BAFA) is a rare phenomenon commonly accompanying other aneurysms. Treatment is challenging, and few cases have been reported. This review investigated the management outcomes of BAFAs. METHODS Publication databases were searched to identify studies evaluating outcomes of endovascular treatment (EVT) and microsurgical treatment of BAFAs from inception through 2021. Outcomes (clinical, angiographic, postoperative complications, and retreatment rates) were collected and analyzed. The authors present their case of a patient treated for a BAFA. RESULTS Including the authors' case, 184 patients with 209 BAFAs were reported in 68 studies. Most patients (130/175; 74.3%) presented with ruptured aneurysms, most commonly involving the proximal segment of the BA. Most BAFAs were small (52/103, 50.5%) and saccular (119/143, 83.2%). Most patients underwent EVT (143/184, 77.7%); the rest underwent microsurgery. Postoperative complications after EVT occurred in 10 (8.3%) of 120 patients, with 4 of the 10 experiencing strokes. At clinical follow-up, most EVT patients (74/86, 86.0%) showed good outcomes; 3.9% (2/51) had died. Most aneurysms managed with EVT (56/73, 76.7%) showed complete occlusion at follow-up; 7.3% (8/109) were retreated. Postoperative complications occurred in 62.2% (23/37) of microsurgical patients; 5 (21.7%) of the 23 experienced strokes. All patients showed good clinical outcomes at follow-up. Most aneurysms (22/28, 78.6%) treated microsurgically showed complete occlusion at angiographic follow-up, with no retreatment required. CONCLUSION BAFAs are often symptomatic; thus, treatment is challenging. By the 2000s, treatment had moved from microsurgical to endovascular modalities, with good clinical and angiographic outcomes.
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Affiliation(s)
- Muhammed Amir Essibayi
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Humberto José Madriñán-Navia
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
- Department of Neurosurgery, Center for Research and Training in Neurosurgery, Hospital Universitario de la Samaritana, Bogotá, Colombia
| | - Marian T Park
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Lea Scherschinski
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Emmajane G Rhodenhiser
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Christopher S Graffeo
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Korkmaz M, Çınar C, Nas ÖF, Hakyemez B, Oran İ. Endovascular treatment modalities for basilar artery fenestration aneurysms: experience of two centers and literature review. Turk J Med Sci 2021; 51:1049-1057. [PMID: 33356025 PMCID: PMC8283513 DOI: 10.3906/sag-2006-352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/26/2020] [Indexed: 11/24/2022] Open
Abstract
Background/aim The aim of this study is to present our experience on various endovascular treatment modalities of basilar fenestration aneurysms and reviewing our findings together with literature data. Materials and methods A total of 26 basilar artery fenestration (BAF) aneurysms in 24 patients were endovascularly treated in two different neurointerventional radiology clinics. All patients had been evaluated with computed tomography (CT), CT angiography, and digital subtraction angiography before the procedure. Results Aneurysms of all patients were successfully occluded (technical success rate 100%). Procedure-related complications were seen in two patients. Our comprehensive literature research revealed that studies related with the topic are composed mostly of case reports. In the literature, a total of 113 BAF aneurysms of 101 patients had been treated endovascularly in 46 studies between 1993 and 2019. Success rate of the treatment was reported as 97%, clinical success rate as 91%, and complication rate as 8.8%, while these rates are 100%, 92%, and 7.6% in our study, respectively. Conclusion Although the number of cases is low in our study, to our knowledge, it is the widest series in the literature until today. Our results demonstrate that BAF aneurysms can be treated successfully and safely with different endovascular techniques, with more stent use in recent years.
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Affiliation(s)
- Mehmet Korkmaz
- Department of Radiology, Faculty of Medicine, Kütahya Health Sciences University, Kütahya, Turkey
| | - Celal Çınar
- Department of Radiology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Ömer Fatih Nas
- Department of Radiology, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - Bahattin Hakyemez
- Department of Radiology, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - İsmail Oran
- Department of Radiology, Faculty of Medicine, Ege University, İzmir, Turkey
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Taqi MA, Raz E, Vechera A, Shapiro M, Gupta R, Haynes J, Taussky P, Grandhi R, Riina HA, Nelson PK, Nossek E. Early Experience with Comaneci, a Newly FDA-Approved Controllable Assist Device for Wide-Necked Intracranial Aneurysm Coiling. Cerebrovasc Dis 2021; 50:464-471. [PMID: 33971661 DOI: 10.1159/000514371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Comaneci (Rapid Medical) is a compliant, adjustable mesh that provides temporary scaffolding during coiling of wide-necked intracranial aneurysms (WNAs) that preserves antegrade flow. We report our early multi-institutional experience with the Comaneci device in the USA. METHOD We reviewed all patients with WNAs that were treated using the Comaneci device for coil remodeling of ruptured and unruptured aneurysms at 4 institutions between July 2019 and May 2020. Clinical characteristics, angiographic variables, and endovascular results were assessed. RESULTS A total of 26 patients were included (18 women). The mean age was 62.7 years (range 44-81). Fifteen patients presented with ruptured aneurysms and 11 with unruptured aneurysms. The mean aneurysm neck width was 3.91 mm (range 1.9-6.5) with a mean dome-to-neck ratio of 1.57 (range 0.59-3.39). The mean maximum width was 5.80 mm (range 3.0-9.9) and the mean maximum height was 5.61 mm (range 2.0-11.8). Successful aneurysm occlusion was achieved in 25 of 26 patients. Complete occlusion was achieved in 16 patients, near-complete occlusion was observed in 9 patients, and 1 patient demonstrated residual filling. The mean time of device exposure was 24 min (range 8-76). No vasospasm was observed at the device location. Clot formation on the device was noted in 2 separate cases, but there were no clinical sequelae. There was 1 intraprocedural complication in a case that involved the simultaneous use of 2 Comaneci devices. CONCLUSIONS Our initial experience shows that the Comaneci device is a promising and reliable tool that can safely support coil remodeling of WNAs.
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Affiliation(s)
- M Asif Taqi
- Vascular Neurology of Southern California, Thousand Oaks, California, USA
| | - Eytan Raz
- Department of Radiology, Section of Neurointerventional Radiology, NYU Langone Health, New York, New York, USA
| | - Anastasia Vechera
- Vascular Neurology of Southern California, Thousand Oaks, California, USA
| | - Maksim Shapiro
- Department of Radiology, Section of Neurointerventional Radiology, NYU Langone Health, New York, New York, USA
| | - Rishi Gupta
- Department of Neurosurgery, Wellstar Medical Group, Kennestone Hospital, Atlanta, Georgia, USA
| | - Joseph Haynes
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Philipp Taussky
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Howard A Riina
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Peter Kim Nelson
- Department of Radiology, Section of Neurointerventional Radiology, NYU Langone Health, New York, New York, USA
| | - Erez Nossek
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
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Lim J, Vakharia K, Waqas M, Affana C, Siddiqui AH, Davies JM, Levy EI. Comaneci Device for Temporary Coiling Assistance for Treatment of Wide-Necked Aneurysms: Initial Case Series and Systematic Literature Review. World Neurosurg 2021; 149:e85-e91. [PMID: 33640525 DOI: 10.1016/j.wneu.2021.02.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Coiling of wide-necked aneurysms requires high-density packing of coils within the aneurysm, which necessitates adequate microcatheter access and navigability. The Comaneci device, introduced in the United States in 2019, is a retrievable stent that can be used as an adjunct to coiling of a wide-necked aneurysm without limiting flow. We present a case series and systematic review of use of this device. METHODS All cases involving use of the device at our institute between May 1, 2019, and April 30, 2020, were reviewed. A comprehensive systematic review of the literature was conducted using PubMed and EMBASE and a review of eligible article bibliographies. RESULTS Five patients underwent Comaneci-assisted wide-necked aneurysm coiling during the study period; 4 were treated via a radial artery approach, and 1 was treated via a femoral artery approach. Two patients presented with subarachnoid hemorrhage: 1 had a ruptured posterior inferior cerebellar artery aneurysm (Hunt-Hess 5, Fisher 4), and 1 had a ruptured middle cerebral artery aneurysm (Hunt-Hess 2, Fisher 1). Mean aneurysmal neck size was 4.4 ± 0.8mm; mean aspect ratio was 1.2 ± 0.3. Raymond-Roy 1 occlusion was achieved in all aneurysms except the posterior inferior cerebellar artery aneurysm. Systematic literature review identified 4 articles that found use of the Comaneci device to treat wide-necked aneurysms to be effective. CONCLUSIONS This device can be used with transfemoral and transradial approaches, allowing for continued flow through the parent vessel during the coiling procedure while providing a scaffold for dense coiling of the aneurysm and its neck.
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Affiliation(s)
- Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Kunal Vakharia
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | | | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
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Schmidt RF, Sweid A, Chalouhi N, Avery MB, Sajja KC, Al-Saiegh F, Weinberg JH, Asada A, Joffe D, Zarzour HK, Gooch MR, Rosenwasser RH, Jabbour PM, Tjoumakaris SI. Endovascular Management of Complex Fenestration-Associated Aneurysms: A Single-Institution Retrospective Study and Review of Existing Techniques. World Neurosurg 2020; 146:e607-e617. [PMID: 33130285 DOI: 10.1016/j.wneu.2020.10.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Aneurysms associated with fenestrations of intracranial arteries are exceptionally rare findings. Management strategies for these aneurysms are not well-defined, especially regarding endovascular treatment. We sought to investigate the strategies and feasibility of endovascular treatment approaches for various fenestration-associated intracranial aneurysms. METHODS We performed a retrospective chart review of 2000 aneurysms treated endovascularly, identifying 8 aneurysms located at arterial fenestrations. The technical details and procedural outcomes were reviewed to identify common management approaches, technical nuances, and treatment outcomes. RESULTS There were 3 (37.5%) aneurysms associated with fenestrations of the basilar artery or vertebrobasilar junction. All 3 were successfully treated with a previously undescribed coil-assisted flow-diversion technique, resulting in complete obliteration. Three (37.5%) aneurysms were associated with fenestrations of the anterior communicating artery. Of those, 2 were successfully treated with stent-assisted coil embolization and 1 with coil embolization alone. One (12.5%) aneurysm was associated with a fenestration of the paraclinoid internal carotid artery and 1 (12.5%) aneurysm found was at the takeoff of the posterior inferior cerebellar artery at a fenestration of the vertebral artery. Both were successfully treated with coil-assisted flow diversion. There were no permanent procedural complications. Major considerations for endovascular management of these aneurysms were the dominance of fenestration trunks, aneurysms arising from the fenestration apex or a fenestration limb, amenability to flow diversion, and anticipation of vascular remodeling. CONCLUSIONS Fenestration-associated aneurysms are very rare. We have identified common factors to help guide decision-making for endovascular approaches and demonstrate successful aneurysm treatment using these methods.
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Affiliation(s)
- Richard F Schmidt
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nohra Chalouhi
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael B Avery
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kalyan C Sajja
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Fadi Al-Saiegh
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joshua H Weinberg
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ashlee Asada
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Daniel Joffe
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Hekmat K Zarzour
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - M Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pascal M Jabbour
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Wessels L, de Vries J, Boogaarts HD. The Comaneci Device for Entering an Acute-Angled Small Feeder during Cerebral Arteriovenous Malformation Embolization: A Novel Technique to Support Microcatheterization. Neurointervention 2020; 15:79-83. [PMID: 32570303 PMCID: PMC7412652 DOI: 10.5469/neuroint.2020.00122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/18/2020] [Indexed: 12/25/2022] Open
Abstract
In this report, we describe the use of the Comaneci device to support microcatheterization in a small branch arising from a parent artery during embolization. In 2 cases, arteriovenous malformations presented with intracranial hemorrhage. A microcatheter was navigated into a small feeder while the Comaneci device was deployed just distal to the feeder with an acute angle from the parent artery. Our technical note represents an alternative option of catheterization in cases with difficult access to small feeders originating from higher flow arteries at a sharp angle while maintaining continuous flow in the parent artery.
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Affiliation(s)
- Lars Wessels
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands,Department of Neurosurgery and Center for Stroke Research Berlin (CSB) Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Joost de Vries
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hieronymus D. Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands,Correspondence to: Hieronymus D. Boogaarts, MD, PhD Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmeegen, The Netherlands Tel: +31-024-361-66-04 Fax: +31-024-361-66-00 E-mail:
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