Early experience with a novel net temporary bridging device (Cascade) to assist endovascular coil embolization of intracranial aneurysms

Hernández, David; Gramegna, Laura Ludovica; Aixut, Sònia; Pons, R; Jansen, Olav; Zawadzki, Michał; López-Rueda, Antonio; Parra-Fariñas, Carmen; Piñana, Carlos; Dinia, Lavinia; Arikán, Fuat

doi:10.3171/2019.11.jns192477

Cited by 6 publications

(5 citation statements)

References 14 publications

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“…Among the 11 records that obtained the full text, one was excluded due to data overlap, and one was excluded due to limited information (only an abstract). Therefore, in the final quantitative analysis, we included a total of nine records ( Sirakov et al, 2018 ; Fischer et al, 2020 ; Molina-Nuevo et al, 2020 ; Sirakov S. et al, 2020 ; Sirakov A. et al, 2020 ; Tomasello et al, 2020 ; Lim et al, 2021 ; Taqi et al, 2021 ; Vinacci et al, 2022 ). Please refer to Figure 1 for the specific screening process.…”

Section: Resultsmentioning

confidence: 99%

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A systematic review and meta-analysis of Comaneci/Cascade temporary neck bridging devices for the treatment of intracranial aneurysms

Sun,

Lan,

Sawant

et al. 2023

Front. Hum. Neurosci.

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BackgroundThe 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.MethodsWe 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.ResultsNine 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.ConclusionThe 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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Section: Resultsmentioning

confidence: 99%

“…The study quality was assessed using a modified version of the Newcastle-Ottawa Quality Assessment Scale (NOS; Tomasello et al, 2020 ). Two independent authors evaluated the quality of each study based on the study group’s selection, the study’s comparability, implementation of results of interest, and follow-up data.…”

Section: Methodsmentioning

confidence: 99%

A systematic review and meta-analysis of Comaneci/Cascade temporary neck bridging devices for the treatment of intracranial aneurysms

Sun,

Lan,

Sawant

et al. 2023

Front. Hum. Neurosci.

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“…The adjustable radial force permits a dynamic relationship between the intrasaccular microcatheter and the coils, making it possible to reorient the microcatheter as it is being stabilized, without blocking it. All of these features may have contributed to the high rate of complete occlusion of cerebral aneurysm (MRRC type I in 73.3% of cases) in the first and early multicenter experience [19] .…”

Section: Discussionmentioning

confidence: 99%

“…Not many papers have been published yet and a pre-operatively antiplatelet regimen in the absence of data has not been decided yet [19] .…”

Section: Discussionmentioning

confidence: 99%

Neurovascular Neck-Bridging device in treatment of wide-necked splenic artery aneurysms

Natrella¹,

Perazzini²,

Cristoferi³

et al. 2021

Radiology Case Reports

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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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“…Furthermore, there was no evidence of device related spasm, perforation or coil entanglement. Tomasello et al 21 recently published their multicentre retrospective analysis of 15 patients (11 female) with average age 58 AE 13 years. The majority of the aneurysms were unruptured (n ¼ 10) and 13 aneurysms were located in the anterior circulation.…”

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 experience with a novel net temporary bridging device (Cascade) to assist endovascular coil embolization of intracranial aneurysms

Cited by 6 publications

References 14 publications

A systematic review and meta-analysis of Comaneci/Cascade temporary neck bridging devices for the treatment of intracranial aneurysms

A systematic review and meta-analysis of Comaneci/Cascade temporary neck bridging devices for the treatment of intracranial aneurysms

Neurovascular Neck-Bridging device in treatment of wide-necked splenic artery aneurysms

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

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