Coiling of ruptured, wide-necked basilar tip aneurysm using double Comaneci technique

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.

Large Aneurysm of Basilar Artery Tip Mimicking Midbrain Tumor and Causing Unilateral Obstructive Hydrocephalus: a Case Report and Technical Note

“…This relatively novel technique for protecting/remodeling the aneurysm neck and preserving both posterior cerebral arteries (PCA) consists of Y-Comaneci/balloon configuration, which narrows the effective neck and straightens the vascular bifurcation angle 7,8 . Similar technique but with double Comaneci device was described by Sirakov et al in 2018 9 . A balloon catheter was placed in P1 segment of the right PCA, while a Comaneci bridging device was positioned in P1 segment of the left PCA, thus ensuring both P1 segments to stay open and at least one cerebellar hemisphere to remain constantly/sufficiently blood-supplied, since both the posterior communicating arteries (PComs) were lacking ( Fig.…”

“…Nonetheless, patients with BA apex aneurysms are more likely to be treated by endovascular management, but they have higher recurrence rates when compared with those treated microsurgically 21 . Because of that, Y-configuration balloon-assisted stent coiling, and different bridging expedients, such as the Comaneci device, are advised to induce cerebrovascular remodeling, preserve bilateral PCAs, ensure adequate cerebellar blood supply, and support aneurysm coiling occlusion [6][7][8][9][22][23][24] .…”

“…Similar technique but with double Comaneci device was described by Sirakov et al . in 2018 ( 9 ). A balloon catheter was placed in P1 segment of the right PCA, while a Comaneci bridging device was positioned in P1 segment of the left PCA, thus ensuring both P1 segments to stay open and at least one cerebellar hemisphere to remain constantly/sufficiently blood-supplied, since both the posterior communicating arteries (PComs) were lacking ( Fig.…”

The Cascade device – In vitro tests to assess coil protrusion into the parent vessel

“…[10][11][12] Devices that offer the ability to temporarily cover the neck of the aneurysm but without impeding flow in the parent artery have been developed and may offer certain advantages over balloons. [13][14][15][16][17] One potential complication of these devices is the potential for coils to become entangled with the braids of the device and for this complication to go unrecognised with the potential that a coil can become dislodged from the aneurysm during deflation and removal of the device.…”

The Comaneci Device for Entering an Acute-Angled Small Feeder during Cerebral Arteriovenous Malformation Embolization: A Novel Technique to Support Microcatheterization

“…1 It maintains the advantages of existing adjuvant devices without the risk of parent vessel occlusion during the coiling procedure or the need for long-term antiplatelet medication in case of permanent stenting. [2][3][4][5][6] The device is CE marked and approved in the USA and Canada. The distal end of the device consists of a 7 mm flexible tip, allowing for gentle and safe navigation.…”