The Source for Neurovascular News and Education

September 17, 2019

 

 

Key Points:

 

- Study assesses small cohort of patients with wide-neck intracranial aneurysms coiled with aid of Comaneci bridging device

- Procedures were straightforward, outcomes at least as good as with balloon remodeling 

 

 

Endovascular coiling of intracranial wide neck aneurysms with the assistance of the Comaneci bridging device is straightforward and produces outcomes that are at least as good as with balloon remodeling, a new study shows.

Results of the small series published were online October 14, 2016, ahead of print in the Journal of NeuroInterventional Surgery. 

Sebastian Fischer, MD, of Universitätsklinik Knappschaftskrankenhaus (Bochum, Germany), and colleagues analyzed outcomes of all intracranial aneurysms treated by coil occlusion with the Comaneci device (Rapid Medical, Israel) between December 2014 and November 2015 at their institution. Angiographic and clinical results, including follow-up examinations, were retrospectively analysed. “The aneurysms treated in our cohort were mainly unsuitable for neurosurgical treatment,” Dr. Fisher told Neurovascular Exchange in an email. 

The key advantage of the Comaneci device is that it allows for coiling of aneurysms without blocking distal blood flow the way a balloon does, Tufail Patankar, MD, of Leeds General Infirmary (Leeds, England), told Neurovascular Exchange. “It’s like a stent, but it’s closed at both ends,” he said. “The problem with a stent is the coils can get into the stent, but the Comaneci is made in such a way that it behaves like a balloon without obstructing the [distal] flow.”

Dr. Fischer added that the Comaneci can also be a useful alternative to a stent because it eliminates the need for dual antiplatelet therapy, since the device is fully removed at the end of the procedure.

Overall, the investigators treated 17 patients with 18 aneurysms, all of them unruptured. In 14 cases (77%) successful coil occlusion as intended with assistance from the Comaneci was possible. In the remaining 4 cases (22.2%), insufficient coverage of the aneurysmal neck required modification of the treatment to stent-assisted coiling or balloon remodeling. 

Only one clinically relevant complication occurred. This patient had a right side internal carotid artery posterior communicating aneurysm, and the Comaneci could not be completely “deflated” prior to removal. As a result, the device had to be withdrawn without the protection of the microcatheter. While the postprocedural angiogram revealed no pathological findings, the patient did develop a left-sided hemiparesis within 3 hours after the intervention. Digital subtraction angiography revealed a thrombotic occlusion of the target artery that was successfully recanalized by mechanical thrombectomy. The patient eventually attained a mRS grade of 1, with only mild weakness of the left arm at discharge.

More Tools, Better Matching

“Angiographic outcomes with the Comaneci are comparable with those [of aneurysms] treated with compliant balloons . . . in this small cohort,” Dr. Fischer said. “Further larger studies should compare the clinical and angiographic results with both techniques.”

The Comaneci is a useful addition to the myriad tools available for the endovascular treatment of aneurysms, allowing for better matching between tool and aneurysm location and type, said Dr. Patankar. This particular device is especially useful for sidewall aneurysms that arise from the internal carotid artery. “You can place it across, and you can actually coil the whole aneurysm without compromising the flow distally,” he explained.

“There are still challenges, because it’s still a very new device,” Dr. Patankar acknowledged. “But it’s getting better and better, so I think it’s a very promising device. I don’t think anyone would change the way they would treat aneurysms just because they can use this device. It just helps to treat more difficult aneurysms [with lower risks than those associated with using a balloon].”

 


Source:

Fischer S, Weber A, Carolus A, et al. Coiling of wide-necked carotid artery aneurysms assisted by a temporary bridging device (Comaneci): preliminary experience. J NeuroInterv Surg. 2016;Epub ahead of print.

 

Disclosures:

- Dr. Fischer reports receiving support for travel to meetings, including travel expenses for the meeting of the German Society of Neurosurgery 2016, where the findings of this study were first presented. 

- Dr. Patankar reports no relevant conflicts of interest.