Neurointervention.  2020 Jul;15(2):79-83. 10.5469/neuroint.2020.00122.

The Comaneci Device for Entering an Acute-Angled Small Feeder during Cerebral Arteriovenous Malformation Embolization: A Novel Technique to Support Microcatheterization

• Wessels L
• de Vries J
• Boogaarts HD

• KMID: 2503393
• DOI: http://doi.org/10.5469/neuroint.2020.00122

Abstract

In this report, we describe the use of the Comaneci device to support microcatheterization in a small branch arising from a parent artery during embolization. In 2 cases, arteriovenous malformations presented with intracranial hemorrhage. A microcatheter was navigated into a small feeder while the Comaneci device was deployed just distal to the feeder with an acute angle from the parent artery. Our technical note represents an alternative option of catheterization in cases with difficult access to small feeders originating from higher flow arteries at a sharp angle while maintaining continuous flow in the parent artery.

Keyword

Comaneci; Arteriovenous malformations; Catheterization

Figure

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  Fig. 1. (A–C) Preoperative native computed tomography and digital subtraction angiography (DSA) (lateral and anterior posterior view) of the presented case before treatment. (D, E) DSA with partial embolization, microcatheter before the branch to enter (asterisk), and Comaneci inflated and microwire in the target branch.

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  Fig. 2. (A–C) Preoperative native computed tomography and digital subtraction angiography (DSA) (lateral and anterior posterior view) of the presented case before treatment. (D) DSA microwire in the origin AICA; further advancement is not possible due to a leek of support in the parent artery. (E) Comaneci inflated and microwire in the target branch.

Reference

1. Gupta R, Kolodgie FD, Virmani R, Eckhouse R. Comaneci neck bridging device for the treatment of cerebral aneurysms. J Neurointerv Surg. 2016; 8:181–185.

2. Maingard J, Kok HK, Phelan E, Logan C, Ranatunga D, Brooks DM, et al. Endovascular treatment of wide-necked visceral artery aneurysms using the neurovascular comaneci neck-bridging device: a technical report. Cardiovasc Intervent Radiol. 2017; 40:1784–1791.

3. Sirakov S, Sirakov A, Hristov H, Minkin K, Penkov M, Karakostov V. Early experience with a temporary bridging device (Comaneci) in the endovascular treatment of ruptured wide neck aneurysms. J Neurointerv Surg. 2018; 10:978–982.

4. Sirakov SS, Sirakov A, Hristov H, Raychev R. Coiling of ruptured, wide-necked basilar tip aneurysm using double Comaneci technique. BMJ Case Rep. 2018; 2018:bcr2017222703.

5. Lawson AL, Chandran A, Puthuran M, Goddard T, Nahser H, Patankar T. Initial experience of coiling cerebral aneurysms using the new Comaneci device. J Neurointerv Surg. 2016; 8:e32.

6. Sirakov SS, Panayotova AP, Sirakov AS, Hristov H, Minkin K, Raychev R. Fenestration of the basilar artery associated with aneurysm treated by the support of a temporary bridging device-comaneci: a case report. World Neurosurg. 2018; 119:306–310.

7. Wu EM, El Ahmadieh TY, McDougall CM, Aoun SG, Mehta N, Neeley OJ, et al. Embolization of brain arteriovenous malformations with intent to cure: a systematic review. J Neurosurg. 2019; 132:388–399.