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. 2017 Nov;9(11):1039-1097.
doi: 10.1136/neurintsurg-2016-012664. Epub 2016 Oct 14.

Coiling of wide-necked carotid artery aneurysms assisted by a temporary bridging device (Comaneci): preliminary experience

S Fischer  1 , A Weber  1 , A Carolus  2 , F Drescher  1 , F Götz  3 , W Weber  1
Affiliations

Coiling of wide-necked carotid artery aneurysms assisted by a temporary bridging device (Comaneci): preliminary experience

S Fischer et al. J Neurointerv Surg. 2017 Nov.

Abstract

Background: Endovascular treatment of wide-necked aneurysms remains challenging without the use of adjunctive devices to preserve the parent artery.

Objective: To present our initial experience with a temporary bridging device, the Comaneci (Rapid Medical, Israel). The compliant remodeling mesh protects the parent artery during coil occlusion without flow arrest in the distal vasculature. Permanent dual antiplatelet therapy is not required since the device is fully removed at the end of the procedure.

Methods: All intracranial aneurysms treated by coil occlusion with the Comaneci device between December 2014 and November 2015 were included. Angiographic and clinical results were retrospectively analysed, including follow-up examinations. All aneurysms were unruptured.

Results: 18 aneurysms of the internal carotid artery were included. Successful coil occlusion assisted by the Comaneci device as intended was possible in 14 cases (77.8%). Insufficient coverage of the aneurysmal neck was observed in four cases (22.2%), with modification of the treatment to stent-assisted coiling or remodeling. One clinically relevant complication occurred (5.6%).

Conclusions: Our initial experience shows that use of the Comaneci device is straightforward for the treatment of selected wide-necked aneurysms. Further studies with long-term follow-up data are needed to identify the significance of the presented technique in the neurointerventional armamentarium.

Keywords: Aneurysm; Angiography; Balloon; Device; Intervention.

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Conflict of interest statement

Competing interests: SF: support for travel to meetings—travel expenses for the meeting of the German Society of Neurosurgery 2016.

Figures

Figure 1
Figure 1
Demonstrates the compliant mesh of Comaneci in a broad-based aneurysm model.
Figure 2
Figure 2
(A) Incidental finding of a broad-based internal carotid artery (ICA) paraophthalmic aneurysm; an additional small ICA paraophthalmic aneurysm originating slightly proximal to the ophthalmic artery origin; right anterior-oblique view. (B) Coiling of the aneurysm assisted by the Comaneci device; sufficient coverage of the aneurysm neck; right anterior-oblique view. (C) Final result with near complete occlusion of the aneurysm and stable position of the coils after ‘deflation’ of the Comaneci device; right anterior-oblique view. (D) Follow-up angiography 4 months later demonstrated a complete occlusion of the aneurysm; right anterior-oblique view.
Figure 3
Figure 3
Insufficient coverage of a small internal carotid artery (ICA) paraophthalmic aneurysm owing to an incomplete expansion of the Comaneci device possibly caused by the highly curved segment of the ICA; the treatment strategy was changed to stent-assisted coiling; right anterior-oblique view.
See this image and copyright information in PMC

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