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Abstract
Introduction/Purpose Catheterization of brain arteriovenous malformations (AVMs) can be challenging when small arterial feeders arise with sharp angles. We report the use of the Comaneci device to catheterize a small feeder with hyperacute angle, along with 3-D in-vitro model reconstruction and experimentation of balloon vs Comaneci stent micro-catheterization. We also developed a 3-D model of the arterial anatomy to compare Comaneci vs balloon assisted catheterization of small feeders.
Methods and Methods Patient is a 37-year-old man who presented with sudden onset of severe headache and left sided weakness. Initial CT head and MRA showed left basal ganglia hemorrhage associated with left thalamic AVM. Using a 3D model of the AVM, 30 iterations of micro-catheterization was performed with balloon (Hyperform 4x7mm), Comaneci Petit (24mm length) stent, and without any device assistance (10 each).
Results During the embolization procedure, Comaneci stent provided adequate support distal to the origin of the arterial feeder to the AVM, and the microcatheter was successfully navigated into the small sharply angled feeder (figure 1A). Experimental model showed similar effectiveness of balloon and Comaneci stent with 3/10 first-attempt success rate for micro-catheterization, and 0/10 without any device (figure 1B). Patient tolerated the procedure well with no ischemic or hemorrhagic complications.
Arrow represents the expanded Comaneci Petit stent; Arrowhead shows micro-catheterization using the stent support
Conclusion Comaneci stent showed similar efficacy compared to a balloon for distal micro catherization without distal flow-arrest. Our technical report along with the 3-D model experiments provide insights into the utility of Comaneci vs balloon assisted micro-catherization of the small sharply angled feeders in AVM embolization.
Disclosures H. Saber: None. N. Kaneko: None. S. Tateshima: 2; C; Medtronic, Stryker, Cerenovus. G. Colby: 2; C; Stryker, MicroVention, Medtronic. V. Szeder: None. M. Nour: None. G. Duckwiler: 2; C; Medtronic. R. Jahan: 2; C; Medtronic, Balt.