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

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> The Cascade device offers robust protection of the aneurysmal neck and parent vessel as well as inducing significant intra-aneurysmal flow velocity reduction. </jats:p></jats:sec>

Application of the Neuroform Atlas Stent in Intracranial Aneurysms: Current Status

“…Rescue stenting using the NAS is mainly used in cases of coil protrusion into the parent artery and coil migration (54)(55)(56)(57).…”

“…Many factors can result in coil protrusion into the parent artery, including mismatch between the coil and aneurysm, inadequate positioning of the microcatheter in the aneurysm sac, or a wide aneurysm neck without a balloon or stent (54,55). Coil protrusion can be categorized into the following three grades: in grade I, a loop or coil protrudes into less than half of the main lumen of the parent artery; in grade II, a coil protrudes into more than half of the main lumen of the parent artery; and in grade III, a loop protrudes into more than half of the main lumen of the parent artery (56).…”

The Stream Device—A Retrospective Review of 51 Cases

“…Manually controlled, expandable, braided devices have been clinically used for the treatment of aneurysms [19][20][21][22][23] and, more recently, cerebral vasospasm [24,25]; however, their development and use in AIS are more recent occurrences. The Stream (Perflow Medical, Tel Aviv, Israel) device is a novel device with a braided structure that, via an actuator at the handle, can be expanded or contracted by the operator.…”

Nautilus-assisted coil embolization for a complex AcomA wide-necked aneurysm in the setting of acute subarachnoid hemorrhage

“…[5][6][7] Neck bridging is a conceptually new approach, which provides increased occlusion rates with lower recurrence and complications rates. [8][9][10] The Nautilus (EndoStream Medical) is an intrasaccular bridging device intended to assist in coil embolization of wide-necked cerebral aneurysms. This CE-marked device, available in various sizes, consists of flexible-layers, and is a nitinol-based, detachable implant.…”