Comaneci-Assisted Coiling as a Treatment Option for Acutely Ruptured Wide Neck Cerebral Aneurysm: Case Series of 118 Patients

Autor: Sirakov, Alexander, Minkin, Krasimir, Penkov, Marin, Ninov, Kristian, Karakostov, Vasil, Sirakov, Stanimir
Rok vydání: 2021
Předmět:
medicine.medical_specialty
Wide-necked aneurysms
Subarachnoid hemorrhage
medicine.medical_treatment
AcademicSubjects/MED00930
Neuros/4
Neuros/2
Aneurysm
Ruptured
Bifurcation aneurysms
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Aneurysm
Comaneci device
medicine.artery
medicine
Anterior cerebral artery
Neurosurgery 20/20: Concise
Clear Content
Humans
cardiovascular diseases
Embolization
Retrospective Studies
ComputingMethodologies_COMPUTERGRAPHICS
business.industry
Endovascular remodeling
Coil embolization
Intracranial Aneurysm
Vasospasm
medicine.disease
Embolization
Therapeutic
Cerebral Angiography
Surgery
Anterior communicating artery
Research—Human—Clinical Studies
Treatment Outcome
Middle cerebral artery
Stents
Neurology (clinical)
Internal carotid artery
business
030217 neurology & neurosurgery
Zdroj: Neurosurgery
ISSN: 1524-4040
0148-396X
DOI: 10.1093/neuros/nyaa200_s044
Popis: Background Wide-necked cerebral aneurysms in the setting of acute subarachnoid hemorrhage (SAH) remain difficult to treat with endovascular methods despite recent progress in the neuroendovascular field. Objective To evaluate the effectiveness and safety of the Comaneci device (Rapid Medical, Israel) in endovascular coil embolization of acutely ruptured, wide-necked sidewall, or bifurcation cerebral aneurysms. Methods We retrospectively reviewed 45 anterior communicating artery, 24 internal carotid artery, 21 middle cerebral artery bifurcation, 15 anterior cerebral artery, and 13 posterior circulation aneurysms, which were treated using Comaneci-assisted coil embolization from August 2017 to January 2019. We evaluated procedural complications, clinical outcomes, and mid-term angiographic follow-up. Immediate and 90 d-clinical outcome and radiological follow-up were obtained in all patients. Results Comaneci-assisted coil embolization was performed in 118 acutely ruptured aneurysms. The technique was carried out successfully in all cases. Simultaneous application of 2 separated Comaneci devices was performed in 8/118 cases (6.77%). Periprocedural thromboembolic complications related to the device were seen in 7/118 cases (5.93%) and severe vasospasm of the parent artery after manipulation of the Comaneci device occurred in 5/118 cases (4.2%). The procedural-related morbidity rate was 2.54%, and there was no procedural related mortality. Among the available survivors, angiographic follow-ups were obtained at 3 and 6 mo, and complete aneurysmal obliteration was confirmed in 81/112 (72.3%) and 75/112 (66.9%) cases, respectively. Mid-term follow-up reviewed total recanalization rate of 14.28%. Conclusion Comaneci-assisted embolization of wide-necked intracranial aneurysms in patients presenting with acute SAH is associated with high procedural safety and adequate occlusion rates. Furthermore, dual antiplatelet therapy can be safely avoided in this patient group.
Graphical Abstract Graphical Abstract
Databáze: OpenAIRE
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