Comaneci-Assisted Coiling as a Treatment Option for Acutely Ruptured Wide Neck Cerebral Aneurysm: Case Series of 118 Patients

Sirakov, Alexander; Minkin, Krasimir; Penkov, Marin; Ninov, Kristian; Karakostov, Vasil; Sirakov, Stanimir

doi:10.1093/neuros/nyaa200

Cited by 26 publications

(21 citation statements)

References 35 publications

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“…There are multiple articles in the scientific literature concluding that the use of the Comaneci device is safe and provides adequate occlusion rates in aneurysm embolization [20]. The results of our series are consistent with these other published series and support the usefulness of the Comaneci embolization assist device for the treatment of complex aneurysms, confirming that this device is a real alternative to BAC and SAC.…”

Section: Interpretationssupporting

confidence: 89%

“…In addition, we provide precise technical solutions for the hypothetical case of complications. In this regard, our series shows that the appearance of platelet aggregates is a more common complication than reported in previous publications [ 5 , 6 , 20 ]. The appearance of these aggregates may be related to the time during which the Comaneci device remains deployed in a hypercoagulability scenario.…”

Section: Discussionsupporting

confidence: 58%

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Comaneci device-assisted embolization of wide-necked carotid aneurysms with an unfavorable ratio

et al. 2020

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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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Section: Interpretationssupporting

confidence: 89%

Section: Discussionsupporting

confidence: 58%

Comaneci device-assisted embolization of wide-necked carotid aneurysms with an unfavorable ratio

et al. 2020

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“…However, it provides a controlled user-dependent, sequentially higher degree of radial force, at each incremental increase of the device diameter when compared with the Solitaire stents (figure 2). 11 It is currently FDA-approved as a temporary bridging device for assisted coiling of wide-necked aneurysms, which has been reported in multiple early experience series, with good efficacy and safety profiles 9 26–28. In the present experience with the Comaneci device for mechanical dilation for vasospasm treatment we found it to be successfully navigable into segments distal to the circle of Willis (24.8% of the treated vessels), which can be challenging to access with conventional balloons 16 19 23.…”

Section: Discussionmentioning

confidence: 69%

COManeci MechANical Dilation for vasospasm (COMMAND): multicenter experience

Salem

Khalife

Desai

et al. 2022

J NeuroIntervent Surg

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BackgroundWe report the largest multicenter experience to date of utilizing the Comaneci device for endovascular treatment of refractory intracranial vasospasm.MethodsConsecutive 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.ResultsA 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).ConclusionsThe 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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“…These results compare favorably with previous reports on WNBAs with different techniques and approaches. [13][14][15][16] Intrasaccular flow disruption is an offspring technique derived from the concept of endoluminal flow modulation, and has been applied specifically to WNBAs located at arterial bifurcations. [17][18][19] The implants share common designs that aim to limit the inflow into the aneurysm sac once fully deployed, and promote neoendothelium growth at the aneurysm neck.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of wide-necked intracranial aneurysms using the Nautilus Intrasaccular System: initial case series of 41 patients at a single center

Sirakov

Bhogal

Sirakova

et al. 2022

J NeuroIntervent Surg

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BackgroundEndovascular treatment of intracranial wide-necked and bifurcation aneurysms (WNBA) is technically challenging. The Nautilus Intrasaccular System is designed to provide a mechanical barrier at the aneurysm neck to support coil embolization. We report the results of a single-center series of patients treated for intracranial aneurysms with the Nautilus.MethodsClinical and radiological data were retrospectively collected for all patients treated with the Nautilus for an unruptured or ruptured intracranial aneurysm at our center between March 2021 and March 2022. Clinical outcomes (modified Rankin Scale (mRS) scores), Raymond–Roy angiographic occlusion, recanalization, and complications were measured immediately post-procedure and at 3–6-month follow-up.ResultsA total of 41 patients of mean age 56.7 years (range 37–83 years) were treated with the Nautilus, with 41 saccular aneurysms (18 (43.9%) unruptured and 23 (56.1%) ruptured). The majority of aneurysms (39/41 (95.1%)) were located in the anterior circulation. We experienced no technical complications. One patient had an asymptomatic post-procedural minor stroke related to the procedure. Immediate Class I occlusion was achieved in 30 (73.1%) patients. The rate of all-cause mortality was 7.3% (3/41). One patient was lost to follow-up. At follow-up, 94.5% (35/37) of patients achieved Class I occlusion and 94.5% (35/37) had an mRS score of 0. There were no procedural-related deaths or permanent morbidities at discharge or follow-up.ConclusionThis study demonstrates good safety and effectiveness using the Nautilus Intrasaccular System to treat both ruptured and unruptured intracranial aneurysms. Larger studies are needed to confirm these findings.

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Comaneci-Assisted Coiling as a Treatment Option for Acutely Ruptured Wide Neck Cerebral Aneurysm: Case Series of 118 Patients

Cited by 26 publications

References 35 publications

Comaneci device-assisted embolization of wide-necked carotid aneurysms with an unfavorable ratio

Comaneci device-assisted embolization of wide-necked carotid aneurysms with an unfavorable ratio

COManeci MechANical Dilation for vasospasm (COMMAND): multicenter experience

Endovascular treatment of wide-necked intracranial aneurysms using the Nautilus Intrasaccular System: initial case series of 41 patients at a single center

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