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Nautilus-assisted coil embolization for a complex AcomA wide-necked aneurysm in the setting of acute subarachnoid hemorrhage
  1. Alexander Sirakov1,
  2. Svetozar Matanov1,
  3. Pervinder Bhogal2,
  4. Stanimir Sirakov1
  1. 1 Radiology Department, University Hospital St Ivan Rilski, Sofia, Sofiâ, Bulgaria
  2. 2 Interventional neuroradiology, Royal London Hospital, London, UK
  1. Correspondence to Dr Stanimir Sirakov, Radiology Department, University Hospital St Ivan Rilski, Sofia 1431, Bulgaria; ssirakov{at}


Numerous devices and sophisticated strategies have been developed to further increase the number of aneurysms amenable to endovascular treatment.1–4 Despite the superfluity of available neurovascular armamentarium, wide-necked bifurcation aneurysms can still pose a significant technical challenge to the treating clinician.5–7 Neck bridging is a conceptually new approach, which provides increased occlusion rates with lower recurrence and complications rates.8–10 The Nautilus (EndoStream Medical) is an intrasaccular bridging device intended to assist in coil embolization of wide-necked cerebral aneurysms. This CE-marked device, available in various sizes, consists of flexible-layers, and is a nitinol-based, detachable implant. The device is delivered through a standard microcatheter with a minimal 0.0165" inner diameter and is fully radiopaque and completely resheathable.

Owing to its unique ‘tornado’ like shape the device entirely reconstructs the aneurysmal neck, which facilitates the following coil embolization. In this video 1, we demonstrate the use of Nautilus - assisted coil embolization for a complex anterior communicating artery (AcomA) wide-necked aneurysm in the setting of acute subarachnoid hemorrhage.

Video 1
  • aneurysm
  • subarachnoid
  • hemorrhage
  • device

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  • Contributors AS and SM: wrote the manuscript and edited the video. PB: carried out a critical review. SS: performed the case and final review.

  • 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.