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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) 2024:01787389-990000000-01108. [PMID: 38578712 DOI: 10.1227/ons.0000000000001143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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Kupcs K, Sproge P, Kupca K, Bhogal P. The Stream Device-A Retrospective Review of 51 Cases. J Clin Med 2023; 12:6384. [PMID: 37835028 PMCID: PMC10573462 DOI: 10.3390/jcm12196384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/17/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Mechanical thrombectomy is the gold-standard treatment for patients that have suffered large-vessel occlusion (LVO) stroke. Various different stent-retrievers, aspiration catheters, and techniques have been developed to perform this procedure. We present our initial results regarding the Stream device. MATERIALS AND METHODS We performed a retrospective review of a prospectively maintained database at our high-volume centre to identify all patients treated with the Stream device between February 2021 and January 2023. We recorded baseline demographics, NIHSS, ASPECT scores, eTICI scores, complications, and 90-day mRS. RESULTS We identified 51 patients, 49.0% of whom were male (n = 25), with a median age of 73 (range: 51-89) and a median NIHSS score of 17 (range 4-22), and 68.6% received IV tPA. The median ASPECT score was 10 (range 6-10). Hyperdense clots were seen in 34 cases (66.7%), with a mean clot length of 12 ± 6.2 mm (range 2-26 mm). Clots were located in the anterior circulation in 49 patients. The standard Stream device was used in 78.4% of cases, with Stream 17 being used in 19.6% of cases. The FPE was observed in 25.5% of cases (n = 13), with the mFPE being seen in 31.4% of cases (n = 16). A final eTICI score of ≥2b was achieved in 90.2% of cases (n = 46), and eTICI 2c/3 was seen in 84.3% of cases (n = 43). Furthermore, 24 h CT scans showed that the median ASPECT score was 8 (range 0-10). Good functional outcomes at 90 days (mRS ≤ 2) were achieved in 21.6% of cases (n = 11). CONCLUSIONS The Stream device shows acceptable rates of FPE and mFPE compared to existing devices. Further larger studies are required alongside an understanding of the optimal technique for this device's use.
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Affiliation(s)
- Karlis Kupcs
- Department of Neuroradiology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia; (K.K.); (P.S.); (K.K.)
- Department of Radiology, Riga Stradins University, LV-1007 Riga, Latvia
| | - Patricija Sproge
- Department of Neuroradiology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia; (K.K.); (P.S.); (K.K.)
| | - Katrina Kupca
- Department of Neuroradiology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia; (K.K.); (P.S.); (K.K.)
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, Barts NHS Trust, London E1 1BB, UK
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Sun B, Lan S, Sawant H, Li Y, Ling Y, Zhang B, Wu P, Wang C, Shi H, Xu S. A systematic review and meta-analysis of Comaneci/Cascade temporary neck bridging devices for the treatment of intracranial aneurysms. Front Hum Neurosci 2023; 17:1276681. [PMID: 37817943 PMCID: PMC10560715 DOI: 10.3389/fnhum.2023.1276681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/08/2023] [Indexed: 10/12/2023] Open
Abstract
Background The temporary neck bridging devices represented by Comaneci and Cascade are a type of promising endovascular device for the treatment of intracranial bifurcation or wide-necked aneurysms. This systematic review and meta-analysis aim to assess the efficacy and safety of Comaneci/Cascade devices for the treatment of intracranial aneurysms. Methods We performed a systematic literature search on articles in PubMed, Embase, and Web of Science that evaluated the efficacy and safety of Comaneci/Cascade devices for endovascular treatment of intracranial aneurysms, based on the Preferred Reporting Items for Systematic Reviews and Meta Analytics (PRISMA) guideline. We extracted the characteristics and treatment related information of patients included in the study, recorded the rate of technical success, procedural related complications, and angiographic outcomes. The angiographic outcome was evaluated based on Raymond Roy classification, and adequate occlusion was defined as Raymond Ray I + II. Results Nine studies comprising 253 patients with 255 aneurysms were included. Among them, eight studies were conducted in Europe, one study was conducted in the USA. All these studies were retrospective. 206 aneurysms (80.78%) were ruptured. The vast majority of patients with ruptured aneurysms did not receive antiplatelet therapy. The rate of technical success was 97.1% (95% CI, 94.9 to 99.3%, I2 = 0%). The rate of periprocedural clinical complications was 10.9% (95% CI, 5.4 to 22.1%, I2 = 54%). The rate of complete occlusion (RR1) and adequate occlusion (RR1 + RR2) on immediate angiography after the procedure were 77.7% (95% CI, 72.7 to 83.2%, I2 = 35%) and 98% (95% CI, 95.9 to 100%, I2 = 0%) respectively. The rate of complete occlusion (RR1) and adequate occlusion (RR1 + RR2) on the last follow-up angiography were 81.2% (95% CI, 69.2 to 95.2%, I2 = 81%) and 93.7% (95% CI, 85.6 to 100%, I2 = 69%) respectively, with follow-up range from 3 to 18 months. 22/187 (11.76%) cases of aneurysms progressed during the follow-up period. 39/187 (20.86%) cases of aneurysms received additional treatment during the follow-up period. No fatal complications occurred during the treatment. Conclusion The Comaneci/Cascade device can be used as an auxiliary treatment for intracranial aneurysms, with a good occlusion effect, but the incidence of complications still needs to be monitored.
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Affiliation(s)
- Bowen Sun
- Department of Neurosurgery, The First Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
- Departments of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Shuai Lan
- Department of Neurosurgery, The First Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Harshal Sawant
- Departments of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Yuchen Li
- Department of Neurosurgery, The First Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yeping Ling
- Department of Neurosurgery, The First Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Bohan Zhang
- Department of Pediatric, The First Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Pei Wu
- Department of Neurosurgery, The First Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Chunlei Wang
- Department of Neurosurgery, The First Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Huaizhang Shi
- Department of Neurosurgery, The First Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Shancai Xu
- Department of Neurosurgery, The First Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
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Salem MM, Khalife J, Desai S, Sharashidze V, Badger C, Kuhn AL, Monteiro A, Salahuddin H, Siddiqui AH, Singh J, Levy EI, Lang M, Grandhi R, Thomas AJ, Lin LM, Tanweer O, Burkhardt JK, Puri AS, Gross BA, Nossek E, Hassan AE, Shaikh HA, Jankowitz BT. COManeci MechANical Dilation for vasospasm (COMMAND): multicenter experience. J Neurointerv Surg 2023; 15:864-870. [PMID: 36002289 DOI: 10.1136/jnis-2022-019272] [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: 06/13/2022] [Accepted: 08/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND We report the largest multicenter experience to date of utilizing the Comaneci device for endovascular treatment of refractory intracranial vasospasm. METHODS Consecutive patients undergoing Comaneci mechanical dilatation for vasospasm were extracted from prospectively maintained registries in 11 North American centers (2020-2022). Intra-arterial vasodilators (IAV) were allowed, with the Comaneci device utilized after absence of vessel dilation post-infusion. Pre- and post-vasospasm treatment scores were recorded for each segment, with primary radiological outcome of score improvement post-treatment. Primary clinical outcome was safety/device-related complications, with secondary endpoints of functional outcomes at last follow-up. RESULTS A total of 129 vessels in 40 patients (median age 52 years; 67.5% females) received mechanical dilation, 109 of which (84.5%) exhibited pre-treatment severe-to-critical vasospasm (ie, score 3/4). Aneurysmal subarachnoid hemorrhage was the most common etiology of vasospasm (85%), with 65% of procedures utilizing Comaneci-17 (92.5% of patients received IAV). The most treated segments were anterior cerebral artery (34.9%) and middle cerebral artery (31%). Significant vasospasm drop (pre-treatment score (3-4) to post-treatment (0-2)) was achieved in 89.9% of vessels (96.1% of vessels experienced ≥1-point drop in score post-treatment). There were no major procedural/post-procedural device-related complications. Primary failure (ie, vessel unresponsive) was encountered in one vessel (1 patient) (1/129; 0.8%) while secondary failure (ie, recurrence in previously treated segment requiring retreatment in another procedure) occurred in 16 vessels (7 patients) (16/129; 12.4%), with median time-to-retreatment of 2 days. Favorable clinical outcome (modified Rankin Scale 0-2) was noted in 51.5% of patients (median follow-up 6 months). CONCLUSIONS The Comaneci device provides a complementary strategy for treatment of refractory vasospasm with reasonable efficacy/favorable safety. Future prospective trials are warranted.
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Affiliation(s)
- Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jane Khalife
- Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Sohum Desai
- Department of Neuroscience, Valley Baptist Medical Center, University of Texas Rio Grande Valley School of Medicine, Harlingen, Texas, USA
| | - Vera Sharashidze
- Department of Neurosurgery, New York University School of Medicine, New York, New York, USA
| | - Clint Badger
- Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Anna L Kuhn
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Andre Monteiro
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Hisham Salahuddin
- Department of Neurology, Antelope Valley Medical Center, Lancaster, California, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Jasmeet Singh
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Elad I Levy
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Michael Lang
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Ajith J Thomas
- Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Li-Mei Lin
- Carondelet Neurological Institute, Carondelet Health Network, Tucson, Arizona, USA
| | - Omar Tanweer
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Ajit S Puri
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Bradley A Gross
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Erez Nossek
- Department of Neurosurgery, New York University School of Medicine, New York, New York, USA
| | - Ameer E Hassan
- Department of Neuroscience, Valley Baptist Medical Center, University of Texas Rio Grande Valley School of Medicine, Harlingen, Texas, USA
| | - Hamza A Shaikh
- Department of Neurosurgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
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Lin LM, Collard de Beaufort J, Wang AS, Campos JK, Zarrin DA, Meyer BM, Colby GP, Coon AL. Augmentation of flow diverter vessel wall apposition using the Comaneci device: case experience from a novel, off-label technique. J Neurointerv Surg 2023:jnis-2023-020533. [PMID: 37586816 DOI: 10.1136/jnis-2023-020533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/15/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Flow diversion (FD) embolization of intracranial cerebral aneurysms is an increasingly common modality where treatment success depends on adequate vessel wall apposition of the device. This study aimed to investigate off-label use of the Comaneci device for augmenting vessel wall apposition in post-deployed flow diversion stents (FDS). METHODS Over a 20- month period, all FD cases for the treatment of internal carotid artery (ICA) aneurysms were reviewed. Cases in which the Comaneci device was used to augment vessel wall apposition were analyzed. Data including patient demographics, case characteristics, and procedural outcomes were collected and analyzed as counts. RESULTS From a total of 74 ICA FD cases, the Comaneci device was used to improve vessel wall apposition in 22 cases (29.7%) . Of these cases, 91% were female with a mean patient age of 64.9±11.3 years, and an average aneurysm size of 4.5±2.5 mm. Comaneci device deployment and retrieval was successful in all (100%) cases, with an average fluoroscopy time of 27.3±7.8 min, an average contrast usage of 25.8±13.2 mL, and an average radiation exposure of 915.1±320.8 mGy. Only two cases (9%) required subsequent balloon angioplasty after Comaneci deployment to improve vessel wall apposition throughout the FDS. CONCLUSION Our experience with this technique demonstrates the feasibility of using the Comaneci device for augmentation of FDS vessel wall apposition with 100% success in the deployment and retrieval of the Comaneci device.
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Affiliation(s)
- Li-Mei Lin
- Neurosurgery, Carondelet Neurological Institute, Carondelet Health Network, St. Joseph's Hospital, Tucson, Arizona, USA
| | | | - Alice S Wang
- Neurosurgery, Riverside University Health System, Moreno Valley, California, USA
| | - Jessica K Campos
- Neurosurgery, University of California Irvine, Irvine, California, USA
| | - David A Zarrin
- Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Benjamen M Meyer
- Neurosurgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Geoffrey P Colby
- Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Alexander L Coon
- Neurosurgery, Carondelet Neurological Institute, Carondelet Health Network, St. Joseph's Hospital, Tucson, Arizona, USA
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Adusumilli G, Kobeissi H, Ghozy S, Kallmes KM, Brinjikji W, Kallmes DF, Heit JJ. Comparing Tigertriever 13 to other thrombectomy devices for distal medium vessel occlusion: A systematic review and meta-analysis. Interv Neuroradiol 2023:15910199231152510. [PMID: 36655307 DOI: 10.1177/15910199231152510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND There is limited evidence on the optimal endovascular strategy for treatment of distal medium-vessel occlusions (DMVO). The low-profile Tigertriever 13 stent-triever shows early promise as an adaptable device that can navigate the distal vasculature without increasing complication risk in DMVO. METHODS Using Nested Knowledge, we screened literature for RCTs and cohort studies on the endovascular treatment of DMVO. The primary outcome was reperfusion success, as measured by thrombolysis in cerebral infarction (TICI) ≥ 2b and secondary outcomes included rate of symptomatic intracranial hemorrhage (sICH), mortality at 90 days, and modified Rankin scale (mRS) scores 0-2 at 90 days. A random-effects model was used to compute pooled prevalence rates and their corresponding 95% confidence intervals (CI). RESULTS Eleven studies with 1402 patients, 167 patients treated by Tigertriever 13 and 1235 patients treated by other devices, were included in the meta-analysis. The rate of reperfusion success was similar in patients treated by Tigertriever 13 (83.2% [95% CI: 71.5-96.7%]) versus other devices (81.6% [95% CI: 75.3-88.4%], p > 0.05). The rate of sICH was also similar in patients treated by Tigertriever 13 (7.2% [95% CI: 4.1-12.5%]) versus other devices (6.9% [95% CI: 5.5-8.8%]). There was significant heterogeneity in the reporting of mortality and mRS. CONCLUSIONS Tigertriever 13 had similar rates of reperfusion success and sICH as other devices used for the treatment of DMVO. Heterogeneity in data element reporting prevented further analyses. Further studies evaluating Tigertriever 13 and other potential devices in DMVO should attempt to harmonize data element reporting.
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Affiliation(s)
| | - Hassan Kobeissi
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| | - Sherief Ghozy
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| | | | | | - David F Kallmes
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| | - Jeremy J Heit
- Department of Radiology and Neurosurgery, Stanford University, Stanford, CA, USA
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Comaneci-Assisted Coiling of Wide-Necked Intracranial Aneurysm: A Single-Center Preliminary Experience. J Clin Med 2022; 11:jcm11226650. [PMID: 36431127 PMCID: PMC9696797 DOI: 10.3390/jcm11226650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/01/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Wide-necked aneurysms remain challenging for both coiling and microsurgical clipping. They often require additional techniques to prevent coil prolapse into the parent artery, such as balloon- and stent-assisted coiling. Comaneci is an expandable and removable stent that acts as a bridging device and does not interfere with the blood flow of the parent artery. METHODS We retrospectively reviewed our institutional radiological and clinical chart of patients treated for saccular intracranial aneurysm via endovascular Comaneci-assisted coiling. The aim of the study was to report our preliminary experience in Comaneci-assisted coiling of wide-necked intracranial aneurysms. RESULTS We included 14 patients in the study. Of these, 11 had a ruptured intracranial aneurysm and were treated with Comaneci-assisted coiling. We registered five minor intraprocedural complications and two intraprocedural failures of the device. At one-year follow-up, a satisfying aneurysm occlusion was observed in 85% of the cases. CONCLUSIONS Though long-term follow-up data and larger case series are needed, this preliminary study showed the feasibility of the Comaneci-assisted coiling method for both ruptured and unruptured wide-neck intracranial aneurysms, with similar occlusion rates as balloon-assisted coiling. However, we registered high incidence of thromboembolic complications; these were probably related to the lack of heparin administration. The main advantageous application of this technique is likely in cases of ruptured intracranial aneurysms, as there is no need for post-procedural antiplatelet therapy.
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Wang M, Elens S, Bonnet T, Halut M, Suarez JV, Mine B, Lubicz B, Guenego A. The Anch'Or Harpoon Technique With a Manually Expandable Stentretriever (Tigertriever 13), a Technical Note. Front Neurol 2022; 13:934690. [PMID: 35959403 PMCID: PMC9362149 DOI: 10.3389/fneur.2022.934690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background and purpose Stent and balloon anchor techniques have been described to obtain distal support and straighten catheter loops, stabilize microcatheters in giant aneurysms, or access distal tortuous anatomy during thrombectomy. These techniques require catheterization of distal arteries with a microcatheter but tortuosity and length issues may render it challenging, precluding the distal unsheathing of a classical auto-expandable stentretriever with the anchor technique. Methods Therefore, we developed the so-called Anch'Or Harpoon Technique using a manually expandable stent retriever, the Tigertriever 13 (Rapid Medical, Yoqneam, Israel). Here, the stent retriever is not unsheathed but pushed out of a microcatheter, and then advanced as far as possible before manual opening. Results and conclusion This technique may be used in 2 different situations. First, in the case of vessel tortuosity if the microcatheter can't be advanced as far as the physician wants: the Tigertriever 13 could be delivered through the microcatheter without having to unsheathe it, and be advanced and opened distally to its microcatheter to establish a stable anchor prior to advancing the guiding, intermediate, and micro-catheters (Anchor technique). The second situation is when distal occlusions lead to length issues; the microcatheter may be too short to cross a distal clot: the Tigertriever 13 could then be pushed out of the microcatheter, and be used to cross a sub-occlusive clot as it has a soft shaped distal tip and the physician has a visual on the artery beyond the sub-occlusion. Then, the Tigertriever would be manually expanded through the clot and retrieved (Harpoon technique) to obtain a recanalization.
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De Leacy R, Bageac DV, Siddiqui N, Bellon RJ, Park MS, Schirmer CM, Woodward KB, Zaidat OO, Spiotta AM. Safety and Long-Term Efficacy Outcomes for Endovascular Treatment of Wide-Neck Bifurcation Aneurysms of the Middle Cerebral Artery: Insights From the SMART Registry. Front Neurol 2022; 13:830296. [PMID: 35197925 PMCID: PMC8860028 DOI: 10.3389/fneur.2022.830296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/06/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Wide-necked middle cerebral artery bifurcation aneurysms pose specific challenges to endovascular management. Surgical clipping remains the standard treatment approach for these aneurysms in many centers. While recent data suggests the endovascular treatment may be comparable, a prospective datapoint has been lacking. Materials and Methods The Penumbra SMART registry, a prospective, multi-center, single-arm outcomes registry of Penumbra coil-treated aneurysms, was queried for endovascularly treated MCA bifurcation aneurysms with wide necks (dome:neck ratio <2 or neck >4 mm). Safety and efficacy outcomes were summarized for ruptured and unruptured aneurysms, including rupture, complication rate, and 1-year occlusion outcomes. Results Seventy-two aneurysms across 31 sites were enrolled. Of these, a total of 15 presented as ruptured aneurysms. Serious adverse events were reported in 21 (29.2%) of patients, with 8 (11.1%) attributed to the device/procedure. Immediately postoperatively, 75.0% of cases achieved “adequate” Raymond Roy Class I (40.3%) or II (34.7%) occlusion outcomes. Of the 72 patients treated, 60 (83.3%) underwent follow-up angiography at 1 year, and among these, 95.0% had 1-year occlusion outcomes of Raymond Roy Class I (71.7%) or II (23.3%). A total of 6 aneurysms (10.0%) were required or were planned for retreatment at the last follow-up. Conclusion This study represents the most significant prospective sample of endovascularly treated wide-neck MCA bifurcation aneurysms conducted to date. It supports the safety and efficacy of endovascular treatment of these aneurysms.
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Affiliation(s)
- Reade De Leacy
- Department of Neurosurgery, Mount Sinai Hospital, New York, NY, United States
| | - Devin V Bageac
- Department of Neurosurgery, Mount Sinai Hospital, New York, NY, United States
| | - Neha Siddiqui
- Department of Neurosurgery, Mount Sinai Hospital, New York, NY, United States
| | | | - Min S Park
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States
| | - Clemens M Schirmer
- Department of Neurosurgery and Neuroscience Institute, Geisinger Health System, Wilkes-Barre, PA, United States.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | | | | | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, United States
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Sirakov A, Bhogal P, Bogovski S, Matanov S, Minkin K, Hristov H, Ninov K, Karakostov V, Penkov M, Sirakov S. Comaneci plus Balloon-assisted Embolization of Ruptured Wide-necked Cerebral Aneurysms. Clin Neuroradiol 2022; 32:773-782. [PMID: 35041011 DOI: 10.1007/s00062-021-01115-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/19/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Recently, avant-garde combinations of ancillary devices as an adjunct to coil embolization for acutely ruptured and wide-necked cerebral aneurysms have emerged. This study sought to investigate the feasibility, safety and durability of the simultaneous combination of temporary neck-bridging devices plus balloon-assisted coiling (BAC) to treat acutely ruptured and wide-necked cerebral aneurysms. METHODS A retrospective review was performed of patients with ruptured and wide-necked intracranial bifurcation aneurysms treated with temporary stent plus balloon-assisted coiling. Anatomical features, technical details, intraprocedural complications, clinical and angiographic results were reviewed. Preprocedural and follow-up clinical statuses were evaluated using the modified Rankin scale (mRS). RESULTS A total of 21 patients (mean age 54.5 years, range 37-72 years) were identified. The immediate postprocedural angiography revealed complete aneurysm occlusion in 85.7% (18/21) of the cases. A periprocedural complication developed in 9.5% of the cases. There was no mortality in this study. The permanent morbidity rate was 4.7%. Long-term follow-up angiography was performed in 18 of 21 patients (85.7%) (the mean follow-up period was 21 months). The rate of complete aneurysm occlusion at final follow-up was 89.4%. CONCLUSION The results of this study confirmed that temporary stent plus balloon-assisted coiling is a durable and relatively safe endovascular technique for the treatment of ruptured wide-necked bifurcation aneurysms located in both the posterior and anterior cerebral circulation.
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Affiliation(s)
- A Sirakov
- Radiology Department, UH St Ivan Rilski, 1431, Sofia, Bulgaria.
| | - P Bhogal
- Interventional Neuroradiology Department, The Royal London Hospital, London, UK
| | - S Bogovski
- Radiology Department, UH St Ivan Rilski, 1431, Sofia, Bulgaria
| | - S Matanov
- Radiology Department, UH St Ivan Rilski, 1431, Sofia, Bulgaria
| | - K Minkin
- Neurosurgery Department, UH St Ivan Rilski, Sofia, Bulgaria
| | - H Hristov
- Neurosurgery Department, UH St Ivan Rilski, Sofia, Bulgaria
| | - K Ninov
- Neurosurgery Department, UH St Ivan Rilski, Sofia, Bulgaria
| | - V Karakostov
- Neurosurgery Department, UH St Ivan Rilski, Sofia, Bulgaria
| | - M Penkov
- Radiology Department, UH St Ivan Rilski, 1431, Sofia, Bulgaria
| | - S Sirakov
- Radiology Department, UH St Ivan Rilski, 1431, Sofia, Bulgaria
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11
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Guenego A, Mine B, Bonnet T, Elens S, Vazquez Suarez J, Jodaitis L, Ligot N, Naeije G, Lubicz B. Thrombectomy for distal medium vessel occlusion with a new generation of Stentretriever (Tigertriever 13). Interv Neuroradiol 2021; 28:444-454. [PMID: 34516332 PMCID: PMC9326865 DOI: 10.1177/15910199211039926] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To evaluate the safety and efficacy of the Tigertriever 13 (Rapid Medical, Yoqneam, Israel) stent retriever in acute ischemic stroke (AIS) patients with primary or secondary distal, medium vessel occlusions (DMVO). METHODS We performed a retrospective analysis of all consecutive AIS patients who underwent thrombectomy with the Tigertriever13 for DMVO. Patients' characteristics were reviewed, procedural complications, angiographic (modified thrombolysis in cerebral infarction score [mTICI]) and clinical (modified Rankin Scale [mRS]) outcomes were documented. RESULTS Between November 2019 and November 2020, 16 patients with 17 DMVO were included (40% female, median age 60 [50-65] years). The Tigertriever13 was used in 11/17 (65%, median NIHSS of 8 [6-15]) primary DMVO and in 6/17 (35%, median NIHSS of 20 [13-24]) cases of secondary DMVO after a proximal thrombectomy. The successful reperfusion rate (mTICI 2b, 2c, 3) was 94% (16/17) for the dedicated vessel. At day 1, CT imaging showed a subarachnoid hemorrhage in 29% of the cases and a parenchymal hematoma in 12%. At 3 months, 65% of the patients (11/17) had a favorable outcome (mRS 0-2). CONCLUSION Mechanical thrombectomy using the Tigertriever13 appears to be safe and effective for DMVO. Clinical and anatomical results are in line with those of patients with proximal occlusions.
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Affiliation(s)
- Adrien Guenego
- Department of Interventional Neuroradiology, 70496Erasme University Hospital, Brussels, Belgium
| | - Benjamin Mine
- Department of Interventional Neuroradiology, 70496Erasme University Hospital, Brussels, Belgium
| | - Thomas Bonnet
- Department of Interventional Neuroradiology, 70496Erasme University Hospital, Brussels, Belgium
| | - Stephanie Elens
- Department of Interventional Neuroradiology, 70496Erasme University Hospital, Brussels, Belgium
| | - Juan Vazquez Suarez
- Department of Interventional Neuroradiology, 70496Erasme University Hospital, Brussels, Belgium
| | - Lise Jodaitis
- Department of Neurology, 70496Erasme University Hospital, Brussels, Belgium
| | - Noémie Ligot
- Department of Neurology, 70496Erasme University Hospital, Brussels, Belgium
| | - Gilles Naeije
- Department of Neurology, 70496Erasme University Hospital, Brussels, Belgium
| | - Boris Lubicz
- Department of Interventional Neuroradiology, 70496Erasme University Hospital, Brussels, Belgium
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12
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Natrella M, Perazzini C, Cristoferi M, Furfaro D, Alessi M, Fanelli G. Neurovascular Neck-Bridging device in treatment of wide-necked splenic artery aneurysms. Radiol Case Rep 2021; 16:2404-2410. [PMID: 34257769 PMCID: PMC8260741 DOI: 10.1016/j.radcr.2021.05.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/16/2022] Open
Abstract
We report the cases of 2 female patients, 45-year-old and 49-year-old, affected by wide-necked splenic aneurysm. We embolized the 2 lesions assisted by a new scaffolding neurovascular device, the Cascade Net, an innovative –occlusive remodeling device for temporary bridging in endovascular coil embolization of intracranial aneurysms. Visceral artery aneurysms are rare with an estimated prevalence of 2%-3% in imaging series and up to 10% in autopsy series. Most are asymptomatic and their diagnosis is occasionally. Aneurysm spontaneous rupture has been demonstrated in 2%-10% of cases and it can result in significant morbidity and mortality. Conservative management and open repair were the preferred treatment options for many years. Endovascular repair has been increasingly used since 2000; and the most widespread method of treatment has been coiling. Because of tortuosity of the parent artery, wide neck, and unfavorable locations at arterial branch points, 6% of Visceral and renal artery aneurysms VRAA cannot be adequately treated by simple coiling and requires parent artery remodeling through balloon occlusion, stent placement or parent vessel occlusion, leading to, in the latter situation, a compromised organ perfusion. Increasingly, balloon-assisted, and stent-assisted approaches as well as novel scaffolding neurovascular devices such as the Cascade Net, have allowed wide necked aneurysms to be bridged during endovascular treatment with smaller delivery system, averting parent artery occlusion and risk of distal embolization.
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Affiliation(s)
| | - Chiara Perazzini
- Department of Radiology, Parini Hospital, Viale Ginevra, 3, 11100, Aosta, Italy
| | - Massimo Cristoferi
- Department of Radiology, Parini Hospital, Viale Ginevra, 3, 11100, Aosta, Italy
| | - Dany Furfaro
- Department of Radiology, Parini Hospital, Viale Ginevra, 3, 11100, Aosta, Italy
| | - Monica Alessi
- Department of Radiology, Parini Hospital, Viale Ginevra, 3, 11100, Aosta, Italy
| | - Gianluca Fanelli
- Department of Radiology, Parini Hospital, Viale Ginevra, 3, 11100, Aosta, Italy
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13
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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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14
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Combination of temporary bridging device (Comaneci) and permanent stenting in the treatment of unruptured wide neck bifurcation aneurysms. Neuroradiology 2021; 63:975-980. [PMID: 33677621 DOI: 10.1007/s00234-021-02677-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
The double stent-assisted techniques for the treatment of wide neck bifurcation aneurysms (WNBAs) may be more complicating than single stent-assisted or balloon-assisted coiling. The Comaneci device (Rapid Medical, Yokneam, Israel) is a new temporary bridging device developed for covering the aneurysm neck during coiling. This new design enabled us to treat unruptured WNBAs with the use of single stent-assisted coiling instead of double stent in eight patients. At the 1-year angiographic follow-up, there was no filling in any aneurysm. There was no mortality or morbidity cases related to the procedure. In this study, we are reporting our experience of using single stent-assisted coiling combined with a Comaneci device in the treatment of unruptured WNBAs.
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15
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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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16
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Sirakov A, Minkin K, Penkov M, Ninov K, Karakostov V, Sirakov S. Comaneci-Assisted Coiling as a Treatment Option for Acutely Ruptured Wide Neck Cerebral Aneurysm: Case Series of 118 Patients. Neurosurgery 2020; 87:1148-1156. [PMID: 32453823 PMCID: PMC7666901 DOI: 10.1093/neuros/nyaa200] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 03/19/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Wide-necked cerebral aneurysms in the setting of acute subarachnoid hemorrhage (SAH) remain difficult to treat with endovascular methods despite recent progress in the neuroendovascular field. OBJECTIVE To evaluate the effectiveness and safety of the Comaneci device (Rapid Medical, Israel) in endovascular coil embolization of acutely ruptured, wide-necked sidewall, or bifurcation cerebral aneurysms. METHODS We retrospectively reviewed 45 anterior communicating artery, 24 internal carotid artery, 21 middle cerebral artery bifurcation, 15 anterior cerebral artery, and 13 posterior circulation aneurysms, which were treated using Comaneci-assisted coil embolization from August 2017 to January 2019. We evaluated procedural complications, clinical outcomes, and mid-term angiographic follow-up. Immediate and 90 d-clinical outcome and radiological follow-up were obtained in all patients. RESULTS Comaneci-assisted coil embolization was performed in 118 acutely ruptured aneurysms. The technique was carried out successfully in all cases. Simultaneous application of 2 separated Comaneci devices was performed in 8/118 cases (6.77%). Periprocedural thromboembolic complications related to the device were seen in 7/118 cases (5.93%) and severe vasospasm of the parent artery after manipulation of the Comaneci device occurred in 5/118 cases (4.2%). The procedural-related morbidity rate was 2.54%, and there was no procedural related mortality. Among the available survivors, angiographic follow-ups were obtained at 3 and 6 mo, and complete aneurysmal obliteration was confirmed in 81/112 (72.3%) and 75/112 (66.9%) cases, respectively. Mid-term follow-up reviewed total recanalization rate of 14.28%. CONCLUSION Comaneci-assisted embolization of wide-necked intracranial aneurysms in patients presenting with acute SAH is associated with high procedural safety and adequate occlusion rates. Furthermore, dual antiplatelet therapy can be safely avoided in this patient group.
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Affiliation(s)
| | | | | | | | | | - Stanimir Sirakov
- Correspondence: Stanimir Sirakov, MD, PhD UH St Ivan Rilski, Radiology Department, Bul. Akad. Ivan Geshov 15, Sofia, Bulgaria 1431.
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17
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Molina-Nuevo JD, López-Martínez L, Pedrosa-Jiménez MJ, Juliá-Molla E, Hernández-Fernández F. Comaneci device-assisted embolization of wide-necked carotid aneurysms with an unfavorable ratio. BMC Neurol 2020; 20:384. [PMID: 33092561 PMCID: PMC7584075 DOI: 10.1186/s12883-020-01963-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 10/16/2020] [Indexed: 01/03/2023] Open
Abstract
Background Endovascular treatment is the technique of choice for most intracranial aneurysms. However, the treatment of morphologically complex wide-necked aneurysms with an unfavorable anatomy is still a therapeutic challenge. The purpose of the study is to describe the initial experience with the Comaneci embolization assist device for the treatment of wide-necked aneurysms with an unfavorable ratio for direct embolization. Methods We report a retrospective single-center analysis taken from a prospective database of consecutive aneurysms of the anterior circulation treated using the Comaneci device in the period from March 2017 to March 2019. Results Eighteen aneurysms were collected from 16 patients (9 women and 7 men) treated using the Comaneci device. The mean age was 48.4 years (range 36–81). Twelve patients had SAH, three were incidental aneurysms and one had compressive symptoms. A complete asymptomatic occlusion rate of 88.8% was obtained. The major complication rate was 5.55%. Conclusion The Comaneci embolization assist device is a safe, effective option for endovascular treatment of complex aneurysms with an unfavorable ratio.
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Affiliation(s)
- Juan David Molina-Nuevo
- Radiology department, Complejo Hospitalario Universitario Albacete, Albacete, Spain. .,C. Hospitalario Universitario de Albacete, C. Hermanos Falcó nº 37. CP, 02006, Albacete, Spain.
| | | | | | - Enrique Juliá-Molla
- Radiology department, Complejo Hospitalario Universitario Albacete, Albacete, Spain
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18
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Comaneci-Assisted Coiling Embolization of a Posttraumatic Carotid-Cavernous Fistula. World Neurosurg 2020; 141:166-170. [DOI: 10.1016/j.wneu.2020.05.185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/20/2020] [Indexed: 11/19/2022]
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Oushy S, Rinaldo L, Brinjikji W, Cloft H, Lanzino G. Recent advances in stent-assisted coiling of cerebral aneurysms. Expert Rev Med Devices 2020; 17:519-532. [PMID: 32500761 DOI: 10.1080/17434440.2020.1778463] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Stent-assisted coiling (SAC) of intracranial aneurysms paved the way for endovascular coiling of wide-neck and bifurcation aneurysms, improving rates of aneurysm obliteration and recurrence. In this review, we provide a comprehensive review of the most recent advances related to stent-assisted coiling of intracranial aneurysm. AREAS COVERED The authors have made an attempt to cover the inception, applications, and limitations of SAC of intracranial aneurysms. Special focus is given to 1) the current and recently introduced SAC techniques, 2) most recent advances in device technology, and 3) outcome data for the discussed techniques and devices. The authors also discuss the potential future direction of SAC. EXPERT OPINION technical refinements in the field of SAC should continue to focus on device development and addressing the limitations of SAC, namely aneurysm recurrence and need of antiplatelet agents. Although the recurrence rate of SAC has not been shown to be inferior to flow diverters, the use of intrasaccular and intravascular flow diverters are likely to expand in the future at the expense of SAC.
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Affiliation(s)
- Soliman Oushy
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA
| | - Lorenzo Rinaldo
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA.,Department of Radiology, Mayo Clinic , Rochester, MN, USA
| | - Harry Cloft
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA.,Department of Radiology, Mayo Clinic , Rochester, MN, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA.,Department of Radiology, Mayo Clinic , Rochester, MN, USA
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Will L, Maus V, Maurer C, Weber A, Weber W, Fischer S. Mechanical Thrombectomy in Acute Ischemic Stroke Using a Manually Expandable Stent Retriever (Tigertriever) : Preliminary Single Center Experience. Clin Neuroradiol 2020; 31:491-497. [PMID: 32529306 DOI: 10.1007/s00062-020-00919-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/20/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the safety and efficacy of a manually expandable stent retriever (Tigertriever, Rapid Medical, Yoqneam, Israel) in the treatment of acute ischemic stroke caused by intracranial large vessel occlusions (LVO). METHODS We performed a single center retrospective analysis of all patients treated by mechanical thrombectomy due to LVO using the Tigertriever. The angiographic and clinical success was evaluated by the modified thrombolysis in cerebral infarction score (mTICI) and the modified Rankin score (mRS). RESULTS A total of 68 acute intracranial arterial occlusions in 61 patients (42 female, median age 77 years, range 43-92 years) were treated by mechanical thrombectomy using the Tigertriever. The overall successful reperfusion rate (mTICI 2b-3) was 85.3% (58/68 occlusions) with a first pass effect (mTICI 3) of 23.5% (16/68 occlusions). In 57 of the 68 occlusions the Tigertriever was used on an intention to treat approach with a success rate of 86.0% and in the 11 remaining occlusions where the Tigertriever was used as a bail-out device the success rate was 81.9%. In seven patients a mild subarachnoid hemorrhage occurred (11.5%) and one symptomatic intracerebral hemorrhage was observed (1.6%). At discharge 39.3% of the patients (24/61) had a favorable outcome (mRS 0-2). CONCLUSION The Tigertriever offers a safe and effective treatment option in ischemic stroke due to LVOs with reperfusion rates and a safety profile similar to alternative devices. The Tigertriever is a promising bail-out tool in complex cases. Its role as a first line device has to be evaluated in further prospective studies.
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Affiliation(s)
- L Will
- Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie und Nuklearmedizin, Knappschaftskrankenhaus Bochum-Universitätsklinikum Bochum, In der Schornau 23-25, 44829, Bochum, Germany
| | - V Maus
- Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie und Nuklearmedizin, Knappschaftskrankenhaus Bochum-Universitätsklinikum Bochum, In der Schornau 23-25, 44829, Bochum, Germany
| | - C Maurer
- Klinik für Diagnostische, Radiologie und Neuroradiologie, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - A Weber
- Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie und Nuklearmedizin, Knappschaftskrankenhaus Bochum-Universitätsklinikum Bochum, In der Schornau 23-25, 44829, Bochum, Germany
| | - W Weber
- Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie und Nuklearmedizin, Knappschaftskrankenhaus Bochum-Universitätsklinikum Bochum, In der Schornau 23-25, 44829, Bochum, Germany
| | - S Fischer
- Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie und Nuklearmedizin, Knappschaftskrankenhaus Bochum-Universitätsklinikum Bochum, In der Schornau 23-25, 44829, Bochum, Germany.
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Bhogal P, Wong K, Makalanda H. The Cascade device - In vitro tests to assess coil protrusion into the parent vessel. Interv Neuroradiol 2020; 26:494-500. [PMID: 32393085 DOI: 10.1177/1591019920925708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Balloon and stent-assisted coiling of aneurysms have increased the number of aneurysms available for endovascular treatment. Newer devices that allow flow within the parent vessel but coverage at the neck have recently entered the market. The Cascade is a new non-occlusive fully retrievable neck-bridging support device that has been designed to provide temporary support during coil embolisation of intracranial aneurysms. METHODS Using a silicone aneurysm model three different aneurysms were catheterised with the coiling microcatheter placed in three different positions within each aneurysm - at the neck, centrally, and looped within the aneurysm. Multiple different coils were then deployed within each aneurysm with the Cascade device deployed across the neck to provide protection. In total 480 attempted coilings were performed. Aneurysm flow was used to calculate the change in intra-aneurysmal flow with the Cascade device deployed across the neck of the aneurysm. RESULTS We did not observe a single episode of coil protrusion through the Cascade mesh nor did we observe any coil protrusion into the parent vessel when the Cascade was deployed across the neck. There was an average flow velocity reduction of 23% with the Cascade device deployed across the neck of the aneurysm. CONCLUSION The Cascade device offers robust protection of the aneurysmal neck and parent vessel as well as inducing significant intra-aneurysmal flow velocity reduction.
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Affiliation(s)
- P Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, London, UK
| | - K Wong
- Department of Interventional Neuroradiology, The Royal London Hospital, London, UK
| | - Hld Makalanda
- Department of Interventional Neuroradiology, The Royal London Hospital, London, UK
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22
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Tomasello A, Hernandez D, Gramegna LL, Aixut S, Barranco Pons R, Jansen O, Zawadzki M, Lopez-Rueda A, Parra-Fariñas C, Piñana C, Dinia L, Arikan F, Rovira A. Early experience with a novel net temporary bridging device (Cascade) to assist endovascular coil embolization of intracranial aneurysms. J Neurosurg 2020; 134:591-599. [PMID: 31978881 DOI: 10.3171/2019.11.jns192477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/18/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to evaluate the effectiveness and safety of a new noncompletely occlusive net-assisted remodeling technique in which the Cascade net device is used for temporary bridging of intracranial aneurysms. METHODS Between July 2018 and May 2019, patients underwent coil embolization with the Cascade net device within 4 centers in Europe. Analysis of angiographic (modified Raymond-Roy classification [MRRC]) and clinical outcomes data was conducted immediately following treatment and at the 6-month follow-up. RESULTS Fifteen patients were included in the study (mean age 58 ± 13 years, 11/15 [73.3%] female). Ten patients had unruptured aneurysms, and 5 presented with ruptured aneurysms with acute subarachnoid hemorrhage. The mean aneurysm dome length was 6.27 ± 2.33 mm and the mean neck width was 3.64 ± 1.19 mm. Immediately postprocedure, MRRC type I (complete obliteration) was achieved in 11 patients (73.3%), whereas a type II (residual neck) was achieved in 4 patients (26.7%). Follow-up examination was performed in 7/15 patients and showed stabilization of aneurysm closure with no thromboembolic complications and only 1 patient with an increased MRRC score (from I to II) due to coil compression. CONCLUSIONS Initial experience shows that the use of a new noncompletely occlusive net-assisted remodeling technique with the Cascade net device may be safe and effective for endovascular coil embolization of intracranial aneurysms.
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Affiliation(s)
- Alejandro Tomasello
- 1Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona
- 2Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
| | - David Hernandez
- 1Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona
- 2Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Ludovica Gramegna
- 2Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
- 3IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy
| | - Sonia Aixut
- 4Department of Neuroradiology, Hospital Universitari de Bellvitge de Llobregat, Barcelona, Spain
| | - Roger Barranco Pons
- 4Department of Neuroradiology, Hospital Universitari de Bellvitge de Llobregat, Barcelona, Spain
| | - Olav Jansen
- 5Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Michal Zawadzki
- 6Division of Interventional Neuroradiology, Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Carmen Parra-Fariñas
- 2Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Carlos Piñana
- 1Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona
| | - Lavinia Dinia
- 1Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona
- 2Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Fuat Arikan
- 8Department of Neurosurgery, Vall d'Hebron University Hospital, and Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron Research Institute, Barcelona; and
| | - Alex Rovira
- 2Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
- 9Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron University Hospital, Barcelona, Spain
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23
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Park HS, Kwon SC, Park ES, Park JB, Kim MS. A new definition for wide-necked cerebral aneurysms. J Cerebrovasc Endovasc Neurosurg 2019; 21:193-198. [PMID: 32030342 PMCID: PMC6987033 DOI: 10.7461/jcen.2019.21.4.193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/06/2020] [Accepted: 01/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background Endovascular management of wide-necked aneurysms often requires assisted-techniques with adjunctive devices. Wide-necked aneurysm can be defined with a dome-to-neck ratio or aspect ratio; however, clinical definitions of wide-necked aneurysms vary. This study aimed to determine the most useful definition of wide-necked aneurysm to predict the need for an adjunctive device. Methods Among 552 cases of aneurysms, 343 (62.1%) and 209 (37.9%) cases of unruptured and ruptured aneurysms, respectively, were treated in a single institution. For each aneurysm, the (1) dome-to-neck ratio, (2) aspect ratio, and (3) K-ratio (defined as [dome height+maximum dome width]/[2×maximum neck width]) were measured. We statistically analyzed patient data to determine which of the three ratios was most predictive of the need for adjunctive devices. Results Among 552 cases of aneurysms, 277 (50.2%) and 275 (49.8%) cases were treated with and without adjunctive techniques, respectively. The mean dome-to-neck ratio, aspect ratio, and K-ratio were 1.17±0.39, 1.58±0.61, and 1.37±0.47, respectively. The K-ratio was the strongest predictor of the use of adjunctive devices (P<0.001), and 1.3 was the most appropriate K-ratio cut-off value (sensitivity, 72.9%; specificity, 63.6%). Conclusions K-ratio was the most useful predictor of the need for adjunctive devices in the treatment of endovascular aneurysms. These results suggest that the K-ratio may be used to define wide-necked aneurysms requiring complicated management via adjunctive devices.
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Affiliation(s)
- Hyun Seok Park
- Department of Neurosurgery, Dong Kang Medical Center, Ulsan, Korea
| | - Soon Chan Kwon
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Eun Suk Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jun Bum Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Min Soo Kim
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Drescher F, Maus V, Weber W, Fischer S. Pulsatile tinnitus due to an aneurysmatic diverticulum of the jugular bulb treated with the Woven EndoBridge device. Interv Neuroradiol 2019; 26:235-238. [PMID: 31645157 DOI: 10.1177/1591019919881582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tinnitus is a common symptom with an incidence of 4-20%. Pulsatile tinnitus represents a minor subgroup of less than 10% of all patients suffering from tinnitus. Pulsatile tinnitus - different from permanent mostly idiopathic tinnitus is mainly caused by physical sources related to vascular pathologies resulting in a change in blood volume and pressure or an alteration of the vessel lumen. Differential diagnosis for pulsatile tinnitus include dural arteriovenous fistulas, glomus tumors of the jugular foramen and the middle ear or atherosclerotic diseases of the carotid artery in the petrous or cavernous segment. Anomalies of the dural sinuses and the jugular bulb have been described as rare sources of synchronized tinnitus. The Woven EndoBridge (WEB, Microvention, Tustin, CA) is an intraaneurysmal flow diverter for the treatment of broad-based arterial aneurysms with a high safety and effectiveness profile. The initial version of the WEB with a dual layer structure evolved to a single layer structure in two different versions (WEB SL, WEB SLS). The WEB system does not require a concomitant antiplatelet therapy compared to other intraluminal devices as extra-aneurysmal flow-diverters or intracranial stents. Here we describe a case of an aneurysmatic diverticulum of the jugular bulb in a patient with ipsilateral pulsatile tinnitus treated with a WEB device.
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Affiliation(s)
- F Drescher
- Knappschaftskrankenhaus Bochum-Langendreer - Universitätsklinik - Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, Bochum, Germany
| | - V Maus
- Knappschaftskrankenhaus Bochum-Langendreer - Universitätsklinik - Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, Bochum, Germany
| | - W Weber
- Knappschaftskrankenhaus Bochum-Langendreer - Universitätsklinik - Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, Bochum, Germany
| | - S Fischer
- Knappschaftskrankenhaus Bochum-Langendreer - Universitätsklinik - Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, Bochum, Germany
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25
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Sirakov S, Sirakov A, Minkin K, Karakostov V, Raychev R. Early clinical experience with Cascade: a novel temporary neck bridging device for embolization of intracranial aneurysms. J Neurointerv Surg 2019; 12:303-307. [DOI: 10.1136/neurintsurg-2019-015338] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/27/2019] [Accepted: 09/02/2019] [Indexed: 11/04/2022]
Abstract
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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Murray TÉ, Brennan P, Maingard JT, Chandra RV, Little DM, Brooks DM, Kok HK, Asadi H, Lee MJ. Treatment of Visceral Artery Aneurysms Using Novel Neurointerventional Devices and Techniques. J Vasc Interv Radiol 2019; 30:1407-1417. [PMID: 31036460 DOI: 10.1016/j.jvir.2018.12.733] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 12/30/2018] [Accepted: 12/30/2018] [Indexed: 10/26/2022] Open
Abstract
The presence of branching vessels, a wide aneurysm neck, and/or fusiform morphology represents a challenge to conventional endovascular treatment of visceral artery aneurysms. A variety of techniques and devices have emerged for the treatment of intracranial aneurysms, in which more aggressive treatment algorithms aimed at smaller and morphologically diverse aneurysms have driven innovation. Here, modified neurointerventional techniques including the use of compliant balloons, scaffold- or stent-assisted coil embolization, and flow diversion are described in the treatment of visceral aneurysms. Neurointerventional devices and their mechanisms of action are described in the context of their application in the peripheral arterial system.
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Affiliation(s)
- Timothy Éanna Murray
- Department of Interventional Radiology, Beaumont Hospital, Beaumont Road, Dublin, Ireland.
| | - Paul Brennan
- Department of Interventional Neuroradiology, Beaumont Hospital, Beaumont Road, Dublin, Ireland
| | - Julian T Maingard
- Department of Interventional Radiology and Interventional Neuroradiology Unit, Austin Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - Ronil V Chandra
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia
| | - Dilly M Little
- Department of Urology and Transplant Surgery, Beaumont Hospital, Beaumont Road, Dublin, Ireland
| | - D Mark Brooks
- Department of Interventional Radiology and Interventional Neuroradiology Unit, Austin Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - Hong K Kok
- Interventional Radiology Service, Northern Hospital Radiology, Melbourne, Australia
| | - Hamed Asadi
- Department of Interventional Radiology and Interventional Neuroradiology Unit, Austin Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia; Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia
| | - Michael J Lee
- Department of Interventional Radiology, Beaumont Hospital, Beaumont Road, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
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27
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Heo HY, Ahn JG, Ji C, Yoon WK. Selective Temporary Stent-Assisted Coil Embolization for Intracranial Wide-Necked Small Aneurysms Using Solitaire AB Retrievable Stent. J Korean Neurosurg Soc 2019; 62:27-34. [PMID: 30630293 PMCID: PMC6328798 DOI: 10.3340/jkns.2018.0064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 10/12/2018] [Indexed: 12/02/2022] Open
Abstract
Objective Stent-assisted coil embolization of intracranial wide-necked aneurysm requires long-term postoperative antiplatelet therapy to prevent in-stent thrombosis. This study aimed to demonstrate results of temporary stent placement for coiling wide necked small intracranial aneurysms, which eliminated need for antiplatelet agents, and to discuss its feasibility and safety.
Methods Data of 156 patients who underwent stent-assisted coil embolization between 2011 and 2014 were retrospectively analyzed. Thirteen cases of temporary stent-assisted coil embolization were included, and their clinical and radiological results were evaluated.
Results The aneurysms treated were all unruptured except one case. All of them had wide neck with mean dome-to-neck ratio of 0.96 and were small-sized aneurysms with mean maximal diameter of 4.2 mm. There was no technical failure in retrieval of stent after completion of embolization of the target aneurysm. Immediate angiography revealed 11 complete and two partial embolization (one residual neck and one residual aneurysm). Two cases encountered thrombosis complication, and they were managed without neurological sequelae. The mean follow-up period was 43 months, angiographic follow-up revealed two cases with minor recurrence, and clinical outcome was good with modified Rankin scale score of 0.
Conclusion Temporary stent-assisted coil embolization of small wide-necked intracranial aneurysm using fully retrievable stent appears safe and effective. Further application and evaluation of this technique in more cases with larger size aneurysm is warranted.
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Affiliation(s)
- Han Yong Heo
- Department of Neurosurgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Guen Ahn
- Department of Neurosurgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Cheol Ji
- Department of Neurosurgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Ki Yoon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Panagiotopoulos V, Zampakis P, Karnabatidis D, Messinis L, Gatzounis G. Retrieval of Distally Migrated Coil with Direct Aspiration Technique During Temporary Bridging Device Embolization of a Wide-Neck Supraophthalmic Aneurysm. World Neurosurg 2018; 122:294-297. [PMID: 30414519 DOI: 10.1016/j.wneu.2018.10.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dislodgement of coils during endovascular embolization of brain aneurysms is a potentially hazardous complication due to high risk for cerebral infarct and subsequent neurologic deficits or death. We describe a case of whole coil mesh dislodgement due to interaction between the coil loops and a temporary neck-bridging device struts and subsequent successful retrieval of a distally migrated coil into the left middle cerebral artery branch with direct aspiration technique. CASE DESCRIPTION A 32-year-old man was referred to our hospital for treatment of an unruptured wide-neck supraophthalmic aneurysm of the left internal carotid artery. A temporary bridging-neck device was placed and expanded across the aneurysm neck in order to support coil deployment inside the aneurysm sac and avoid coil prolapse into the lumen of the parent vessel. Retrieval of the bridging-neck device after coil embolization resulted in whole coil mesh dislodgement due to interaction between the coil loops and the device struts and finally distal migration of a single coil into the left middle cerebral artery temporal branch. The coil was successfully retrieved using direct aspiration technique similar to thrombectomy in acute ischemic stroke. The patient did not have any neurologic deficit. CONCLUSIONS Our case indicates that first-line direct aspiration technique is an atraumatic and effective procedure for coil retrieval when dislodged even in distal cerebral vessels, minimizing the chance for additional retrieval technique-related risks. Interventionists should be aware of coil dislodgment as a potential temporary bridging-neck device related complication.
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Affiliation(s)
- Vasileios Panagiotopoulos
- Department of Neurosurgery, University Hospital of Patras, Patras, Greece; Department of Endovascular Neurosurgery/Interventional Neuroradiology, University Hospital of Patras, Patras, Greece.
| | - Petros Zampakis
- Department of Endovascular Neurosurgery/Interventional Neuroradiology, University Hospital of Patras, Patras, Greece
| | | | - Lampros Messinis
- Department of Neurology, Neuropsychology Section, University Hospital of Patras, Patras, Greece
| | - Georgios Gatzounis
- Department of Neurosurgery, University Hospital of Patras, Patras, Greece
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Sirakov SS, Sirakov A, Hristov H, Raychev R. Coiling of ruptured, wide-necked basilar tip aneurysm using double Comaneci technique. BMJ Case Rep 2018; 2018:bcr-2017-222703. [PMID: 29776934 PMCID: PMC5965769 DOI: 10.1136/bcr-2017-222703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
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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Affiliation(s)
- Stanimir S Sirakov
- Radiology department, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Alexander Sirakov
- Radiology department, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Hristo Hristov
- Neurosurgery Department, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Radoslav Raychev
- Department of Neurological Surgery, UCI Health, Los Angeles, California, USA
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30
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Early experience with a temporary bridging device (Comaneci) in the endovascular treatment of ruptured wide neck aneurysms. J Neurointerv Surg 2018; 10:978-982. [DOI: 10.1136/neurintsurg-2017-013641] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/28/2017] [Accepted: 01/02/2018] [Indexed: 11/03/2022]
Abstract
BackgroundThe difficulties in obtaining complete and stable endovascular occlusion are most evident for ruptured aneurysms exhibiting a wide neck and unfavorable geometric features. The aim of our study was to present our experience with the Comaneci temporary bridging device in ruptured wide neck aneurysms.MethodsFrom May to July 2017, 29 ruptured aneurysms underwent endovascular embolization with the Comaneci device. Angiographic and clinical results were retrospectively analyzed.Results29 ruptured intracranial aneurysms from different locations were included. Successful embolization was achieved in all lesions; complete post-procedure occlusion was seen in 25 (86%) cases. Insufficient embolization or neck remnant was observed in four cases (13.7%). Complications probably related, directly related, or indirectly related to the device occurred in 3.44% of patients (1/29 patients). At least one angiographic follow-up was performed in each of the 29 cases. The 12 month follow-up examination has yet to be done.ConclusionThe 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.
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31
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Jia ZY, Shi HB, Miyachi S, Hwang SM, Sheen JJ, Song YS, Kim JG, Lee DH, Suh DC. Development of New Endovascular Devices for Aneurysm Treatment. J Stroke 2018; 20:46-56. [PMID: 29402066 PMCID: PMC5836571 DOI: 10.5853/jos.2017.02229] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/28/2017] [Accepted: 01/01/2018] [Indexed: 12/28/2022] Open
Abstract
Since the first use of the Guglielmi detachable coil system for cerebral aneurysm embolization in 1990, various endovascular methods have been developed to treat large numbers of aneurysms. The main strategic and technical modifications introduced to date include balloon-assisted coil embolization, stent-assisted coil embolization, flow diverters, and flow disrupters. The development and introduction of such devices have been so persistent and rapid that new devices are being approved worldwide even before the earlier ones become available in some countries. However, even if some patient populations may possibly benefit from earlier introduction of new devices, the approval authorities should balance the available evidence of the safety and effectiveness of novel devices. This review aims to provide an overview of the recent innovations in endovascular treatment of cerebral aneurysms and a brief review of market access policies and regulations for importing high-risk medical devices, such as those used for endovascular aneurysm management, which correspond to class III devices, as defined by the U.S. Food and Drug Administration. We focus on the current situation in Korea and compare it with that in other Asian countries, such as China and Japan.
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Affiliation(s)
- Zhen Yu Jia
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hai Bin Shi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shigeru Miyachi
- Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Japan
| | - Sun Moon Hwang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Jon Sheen
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yun Sun Song
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joong Goo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Chul Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Maingard J, Kok HK, Phelan E, Logan C, Ranatunga D, Brooks DM, Chandra RV, Lee MJ, Asadi H. Endovascular Treatment of Wide-Necked Visceral Artery Aneurysms Using the Neurovascular Comaneci Neck-Bridging Device: A Technical Report. Cardiovasc Intervent Radiol 2017; 40:1784-1791. [DOI: 10.1007/s00270-017-1733-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/23/2017] [Indexed: 01/02/2023]
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