Fenestration of the Basilar Artery Associated with Aneurysm Treated by the Support of a Temporary Bridging Device—Comaneci: A Case Report

Sirakov, Stanimir; Panayotova, Adriana; Sirakov, Alexander; Hristov, Hristo; Minkin, Krasimir; Raychev, Radoslav

doi:10.1016/j.wneu.2018.08.047

Cited by 8 publications

(5 citation statements)

References 14 publications

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“…Our comprehensive literature research revealed that studies related with the topic are composed mostly of case reports. In the literature, a total of 113 BAF aneurysms of 101 patients had been treated endovascularly in 46 studies between 1993 and 2019 [4][5][6][7][8][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Success rate of the treatment was reported as 97%, clinical success rate as 91%, and complication rate as 8.8%.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment modalities for basilar artery fenestration aneurysms: experience of two centers and literature review

Korkmaz¹,

Çınar²,

Nas³

et al. 2021

Turk J Med Sci

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IntroductionBasilar artery fenestration (BAF) is a rare vascular variation and its incidence is reported as 0.6-2.33% depending on the diagnostic modality chosen [1][2][3]. Fenestrations on this region increase tendency to aneurysm generation [2]. Complex geometric structure of the fenestration, proximity to lower cranial nerves, presence of sort of vital arterial structures, and deep and challenging nature of this region for surgery increase mortality and morbidity of surgical treatment in these aneurysms [4]. Endovascular treatment is becoming the first choice at the present time [5]. However, experiences on endovascular treatment are limited in the literature because of the rarity of these aneurysms.Our aim in this study is to present our experience on various endovascular treatment modalities of basilar fenestration aneurysms and reviewing our findings together with literature data. Materials and methodsA total of 26 BAF aneurysms in 24 patients were endovascularly treated in two different neurointerventional radiology clinics. All patients had been evaluated with computed tomography (CT), CT angiography (CTA), and digital subtraction angiography (DSA) before the procedure. Ruptured and nonruptured aneurysms were included in the study. Patients with aneurysms unrelated to BAF were excluded. Aneurysms were divided into two groups: narrow-necked (neck diameter lower than 4 mm or dome/neck ratio higher than 2) and wide-necked (neck diameter higher than 4 mm or dome/neck ratio lower than 2) [6].All patients were treated with endovascular method under general anesthesia after hospitalization. Systemic heparinization was performed in all patients ensuring an activated clotting time (ACT) of 250-300 s. After femoral artery puncture, angiograms of both carotid and vertebral arteries were obtained selectively. Endovascular Background/aim: The aim of this study is to present our experience on various endovascular treatment modalities of basilar fenestration aneurysms and reviewing our findings together with literature data. Materials and methods:A total of 26 basilar artery fenestration (BAF) aneurysms in 24 patients were endovascularly treated in two different neurointerventional radiology clinics. All patients had been evaluated with computed tomography (CT), CT angiography, and digital subtraction angiography before the procedure.Results: Aneurysms of all patients were successfully occluded (technical success rate 100%). Procedure-related complications were seen in two patients. Our comprehensive literature research revealed that studies related with the topic are composed mostly of case reports. In the literature, a total of 113 BAF aneurysms of 101 patients had been treated endovascularly in 46 studies between 1993 and 2019. Success rate of the treatment was reported as 97%, clinical success rate as 91%, and complication rate as 8.8%, while these rates are 100%, 92%, and 7.6% in our study, respectively. Conclusion:Although the number of cases is low in our study, to our knowledge, it is the widest series in the li...

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Section: Discussionmentioning

confidence: 99%

Endovascular treatment modalities for basilar artery fenestration aneurysms: experience of two centers and literature review

Korkmaz¹,

Çınar²,

Nas³

et al. 2021

Turk J Med Sci

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“…Overall, the majority of aneurysms can be addressed with endovascular treatment; our reported experience demonstrates that this is a durable treatment, even for those aneurysms that are infeasible to clip or that recur after clipping. In cases of rupture, aneurysms should be considered for primary or balloon-assisted coiling (or other temporary neck-bridging devices 25 ). However, if the neck is broad and the dominant fenestration limb is >2 mm in diameter and navigable, we strongly consider using a flow diverter, especially with surface modification to reduce the risk of thromboembolic events.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Embolization of Basilar Artery Fenestration Aneurysms: A 21-Year Institutional Case Series

Srinivasan,

Singh,

Karahalios

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Basilar artery fenestration is a rare phenomenon sometimes associated with basilar artery fenestration aneurysms (BAFAs). This review investigates the natural history and management outcomes of BAFAs and describes the outcomes of BAFAs treated with embolization. METHODS: A single-center database was queried for all cases of endovascular BAFA treatment. Data on complications, clinical and angiographic outcomes, and retreatment rates were collected. RESULTS: Seventeen aneurysms across 17 patients were treated. The mean (SD) age was 56 (13) years, and 15 (88%) patients were women. Among 15 aneurysms with data available, 2 arose from the fenestration limbs and 13 from both limbs and the vertebral artery. Of 16 aneurysmal projections available, 7 projected anteriorly, 7 posteriorly, and 2 superiorly. Among 17 patients, balloon-assisted coiling was the most common treatment (n = 10), followed by primary coiling (n = 3), stent-assisted coiling (n = 2), coiling with flow diversion (n = 1), and balloon-assisted coiling and flow diversion (n = 1). Complications noted in 5 patients included hemorrhage, thromboembolism, paresthesias, vasospasm, and transient hemiparesis. Among 16 patients with postoperative results available, 12 showed favorable clinical outcomes, 3 were disabled, and 1 died. The rates of postoperative complete (Raymond–Roy Occlusion Classification 1) and incomplete (Raymond–Roy Occlusion Classification 2 and 3) occlusion among 15 patients with available data were 6 and 9, respectively. CONCLUSION: Endovascular management of these rare aneurysms is feasible and safe, with high rates of favorable radiographic and clinical outcomes. This series reflects a general preference toward coiling and stent-assisted coiling, although flow diversion may be considered in select cases.

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“…They reported one thromboembolic complication, the precise cause of which was not clear. Multiple reports followed showing promising results with the Comaneci device in the treatment of wide-necked cerebral aneurysms, both unruptured [12] and ruptured [13, 14, 19]. Fisher et al [12] reported one thromboembolic event in their series of 21 cases, while Sirakov et al [13] reported 1 case of 29 in which there was severe intraoperative vasospasm and coil protrusion after retraction of the device.…”

Section: Discussionmentioning

confidence: 99%

Early Experience with Comaneci, a Newly FDA-Approved Controllable Assist Device for Wide-Necked Intracranial Aneurysm Coiling

et al. 2021

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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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Fenestration of the Basilar Artery Associated with Aneurysm Treated by the Support of a Temporary Bridging Device—Comaneci: A Case Report

Cited by 8 publications

References 14 publications

Endovascular treatment modalities for basilar artery fenestration aneurysms: experience of two centers and literature review

Endovascular treatment modalities for basilar artery fenestration aneurysms: experience of two centers and literature review

Endovascular Embolization of Basilar Artery Fenestration Aneurysms: A 21-Year Institutional Case Series

Early Experience with Comaneci, a Newly FDA-Approved Controllable Assist Device for Wide-Necked Intracranial Aneurysm Coiling

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