Coiling of ruptured, wide-necked basilar tip aneurysm using double Comaneci technique

Abstract

In this report, we present a novel technique of successful coil embolisation using temporary deployment of two Comaneci devices placed in Y configuration across a wide-neck ruptured basilar tip aneurysm. The placement of two devices across the wide aneurysm neck allowed optimal coverage for safe coil delivery, while maintaining parent vessel patency. This case highlights the unique and safe applicability of two crossed Comaneci devices in a ruptured aneurysm with unfavourable anatomy, ultimately resulting in complete aneurysm obliteration. To our knowledge, this is the first reported case of double Comaneci usage in a wide-neck ruptured aneurysm. This technique can be potentially applied in challenging wide-neck bifurcation aneurysms, particularly when double antiplatelet therapy is of concern.

Keywords: interventional radiology; neuroimaging.

Figure 1

Road map with both expanded devices after placement of the first coil and control angiogram was performed to ensure optimal wall apposition and patent flow within the parent and distal vessels.

Figure 2

Magnified view demonstrating the deployed Comaneci devices form the distal basilar artery into the bilateral posterior cerebral arteries. Arrows point at the proximal and distal markers of the devices. Magnified unsubtracted images at the completion of the case demonstrating stable and unchanged position of the devices (proximal arrows) and slightly deflected distal marker of the microcatheter within the base of the aneurysm, but outside the parent vessel.

Figure 3

Immediate postprocedure angiogram demonstrating densely packed aneurysm dome with near complete obliteration and widely patent parent posterior cerebral artery and SCAs.

Figure 4

Three-month follow-up angiogram demonstrating completely obliterated aneurysm with no visible contrast penetration within the coil mass and persistently widely patent parent posterior cerebral artery and SCA.