Early clinical experience with Cascade: a novel temporary neck bridging device for embolization of intracranial aneurysms

Sirakov, Stanimir; Sirakov, Alexander; Minkin, Krasimir; Karakostov, Vasil; Raychev, Radoslav

doi:10.1136/neurintsurg-2019-015338

Cited by 16 publications

(12 citation statements)

References 18 publications

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“…Our observations are based on the fact that adjunctive coil embolisation via either temporary or permanent stenting is used in up to 60% of 260 cases annually by our neurointerventional team -SS (senior) and AS (junior). [11][12][13] The early observations indicate that the device's technical behaviour shows subjective non-inferiority in comparison with the already reported preliminary outcomes of its ancestors -LVIS Jr or any other similar low-profile endoluminal device. [14][15][16][17][18][19] In our limited study sample, the implant demonstrated solid technical success with a good safety profile.…”

Section: Discussionmentioning

confidence: 92%

Endovascular treatment of patients with intracranial aneurysms: feasibility and successful employment of a new low profile visible intraluminal support (LVIS) EVO stent

et al. 2020

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Background and purpose Low-profile self-expandable stents have increased the number of intracranial aneurysms treated by endovascular means. The new low-profile visible intraluminal support device LVIS EVO (Microvention), the successor of LVIS Jr, is a self-expandable and retrievable microstent system, designed for implantation into intracranial arteries with a diameter up to 2.0 mm. In this retrospective study we aimed to elucidate the technical feasibility and clinical safety of the novel LVIS EVO stent for stent-assisted coil embolisation of intracranial aneurysms. Materials and methods A single centre technical report of the first six consecutive cases of stent-assisted coil embolisation with the novel LVIS EVO stent for the treatment of unruptured or recanalised intracranial aneurysms. Records were made of basic demographics, aneurysmal characteristics, device properties and related technical details, adverse events, clinical outcomes and occlusion rates on available radiological follow-up. Results Six LVIS EVO devices were successfully implanted in all subjects to treat a total number of six intracranial aneurysms. No device-related intraprocedural complications were seen. At early clinical follow-up six out of six (100%) patients had a modified Ranking score of 0–1. Early angiographic and cross-sectional radiological follow-up, available in five out of six (83.3%) of the patients confirmed unchanged aneurysmal occlusion rates. A minor, transitory neurological deficit was recorded in one of the six (16.6%) patients. Mortality was 0%. Conclusions Preliminary experience in this subset of our patients confirms a notably improved technical behaviour of the novel LVIS EVO stent system when compared to its ancestor LVIS Jr. The enhanced visibility of the stent and the refined delivery/retrieval capabilities of the stent further increase the safety margins of the devices profile, especially in cases of tortuous anatomy.

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Section: Discussionmentioning

confidence: 92%

Endovascular treatment of patients with intracranial aneurysms: feasibility and successful employment of a new low profile visible intraluminal support (LVIS) EVO stent

et al. 2020

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“…Cascade features denser net and deflected shape during expansion unlike Comaneci. Sirakov et al 12 report less coil entanglement and better compliance with parent vessel during expansion with Cascade compared with Comaneci. The authors acknowledge several limitations of their study, such as the small sample size and lack of long-term follow-up.…”

Section: Advances In Stent-assisted Coilingmentioning

confidence: 99%

“…Although the placement of permanent stents during coiling is associated with greater durability, it is also associated with higher risk of thromboembolic complications. In addition, permanent stents require platelet inhibition, increasing the risk of haemorrhagic complications 12. The Cascade and Comaneci devices provide support during coiling and do not require patients to undergo antiplatelet therapy as they are not permanently deployed.…”

Section: Introductionmentioning

confidence: 99%

Advances in endovascular aneurysm management: coiling and adjunctive devices

et al. 2020

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Endovascular coil embolisation continues to evolve and remains a valid modality in managing ruptured and unruptured cerebral aneurysms. Technological advances in coil properties, adjunctive devices and interventional techniques continue to improve long-term aneurysm occlusion rates. This review elaborates on the latest advances in next-generation endovascular coils and adjunctive coiling techniques for treating cerebral aneurysms.on June 9, 2020 by guest. Protected by copyright.

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“…To date there are two publications regarding the Cascade device. Sirakov et al 20 recently published their early clinical experience with the device. In total, 12 patients with aneurysmal subarachnoid haemorrhage underwent coil embolisation with adjunctive use of the Cascade.…”

Section: Discussionmentioning

confidence: 99%

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

2020

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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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Early clinical experience with Cascade: a novel temporary neck bridging device for embolization of intracranial aneurysms

Cited by 16 publications

References 18 publications

Endovascular treatment of patients with intracranial aneurysms: feasibility and successful employment of a new low profile visible intraluminal support (LVIS) EVO stent

Endovascular treatment of patients with intracranial aneurysms: feasibility and successful employment of a new low profile visible intraluminal support (LVIS) EVO stent

Advances in endovascular aneurysm management: coiling and adjunctive devices

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

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