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Case series
Early clinical experience with Cascade: a novel temporary neck bridging device for embolization of intracranial aneurysms
  1. Stanimir Sirakov1,
  2. Alexander Sirakov1,
  3. Krasimir Minkin2,
  4. Vasil Karakostov2,
  5. Radoslav Raychev3
  1. 1 Radiology Department, UH St Ivan Rilski, Sofia, Bulgaria
  2. 2 Neurosurgery Department, UH St Ivan Rilski, Sofia, Bulgaria
  3. 3 Department of Neurology and Comprehensive Stroke Center, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
  1. Correspondence to Dr Radoslav Raychev, UCLA Department of Neurology and Comprehensive Stroke Center, Los Angeles, CA 90095, USA; rudoray{at}


Background Temporary placement of a retrievable neck bridging device, allowing parent vessel flow, is an attractive alternative to balloon remodeling for treatment of ruptured intracranial aneurysms.

Objective To present, in a single-center study, our initial experience with Cascade (Perflow, Israel) in the treatment of ruptured intracranial aneurysms.

Methods During a period of 1.5 months, 12 patients with aneurysmal subarachnoid hemorrhage underwent coil embolization in conjunction with Cascade in our center. Retrospective analysis of prospectively collected angiographic and clinical data was conducted to assess the safety and efficacy of the device.

Results Among all treated patients, 41.7% (5/12) were female, the median age was 55 (47–77) years, the median aneurysm dome size was 5.75 mm (3–9.1), and the median neck size was 3.55 mm (2.3–7.9). Complete obliteration (Raymond 1) was achieved in 75% (9/12) of cases, and intentional residual neck (Raymond 2) was left in three cases (25%). None of the patients received any oral or intravenous antiplatelet therapy perioperatively. No thromboembolic complications, device-related spasm, vessel perforation, or coil entanglement were detected in any of the treated patients.

Conclusions In our initial experience, treatment of wide-neck ruptured intracranial aneurysms with Cascade is safe and effective, without the need for adjuvant antiplatelet therapy. Long-term follow-up data in larger cohorts are needed to confirm these preliminary findings.

  • device
  • aneurysm
  • embolization
  • subarachnoid hemorrhage

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  • SS and RR contributed equally.

  • Contributors SS interpreted the data, drafted a significant portion of the original manuscript, reviewed all suggestions provided by all coauthors, approved the final version, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. RR composed the final version of the manuscript and assumed responsibility for final review and submission as a corresponding author. AS, KM, VK provided a substantial contribution to interpretation of the provided data, contributed with revisions to the original draft, approved the final version of the manuscript, and agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All presented data are available upon request

  • Patient consent for publication Not required.