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  • Augmentation of flow diverter vessel wall apposition using the Comaneci device: case experience from a novel, off-label technique

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New devices and techniques
Case series
Augmentation of flow diverter vessel wall apposition using the Comaneci device: case experience from a novel, off-label technique
  1. Li-Mei Lin1,
  2. Jonathan Collard de Beaufort2,
  3. Alice S Wang3,
  4. Jessica K Campos4,
  5. David A Zarrin5,
  6. Benjamen M Meyer6,
  7. Geoffrey P Colby7,
  8. Alexander L Coon1
  1. 1 Neurosurgery, Carondelet Neurological Institute, Carondelet Health Network, St. Joseph's Hospital, Tucson, Arizona, USA
  2. 2 Syracuse University, Syracuse, New York, USA
  3. 3 Neurosurgery, Riverside University Health System, Moreno Valley, California, USA
  4. 4 Neurosurgery, University of California Irvine, Irvine, California, USA
  5. 5 Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
  6. 6 Neurosurgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
  7. 7 Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
  1. Correspondence to Dr Li-Mei Lin; drlimeilin{at}gmail.com

Abstract

Background Flow diversion (FD) embolization of intracranial cerebral aneurysms is an increasingly common modality where treatment success depends on adequate vessel wall apposition of the device. This study aimed to investigate off-label use of the Comaneci device for augmenting vessel wall apposition in post-deployed flow diversion stents (FDS).

Methods Over a 20- month period, all FD cases for the treatment of internal carotid artery (ICA) aneurysms were reviewed. Cases in which the Comaneci device was used to augment vessel wall apposition were analyzed. Data including patient demographics, case characteristics, and procedural outcomes were collected and analyzed as counts.

Results From a total of 74 ICA FD cases, the Comaneci device was used to improve vessel wall apposition in 22 cases (29.7%) . Of these cases, 91% were female with a mean patient age of 64.9±11.3 years, and an average aneurysm size of 4.5±2.5 mm. Comaneci device deployment and retrieval was successful in all (100%) cases, with an average fluoroscopy time of 27.3±7.8 min, an average contrast usage of 25.8±13.2 mL, and an average radiation exposure of 915.1±320.8 mGy. Only two cases (9%) required subsequent balloon angioplasty after Comaneci deployment to improve vessel wall apposition throughout the FDS.

Conclusion Our experience with this technique demonstrates the feasibility of using the Comaneci device for augmentation of FDS vessel wall apposition with 100% success in the deployment and retrieval of the Comaneci device.

  • Flow Diverter
  • Coil
  • Aneurysm
  • Technique
  • Vessel Wall

https://doi.org/10.1136/jnis-2023-020533

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    Footnotes

    • X @drlimeilin, @benjamen_meyer, @dralexandercoon

    • Contributors L-ML supervised the study, and drafted and revised the article. JCDB collected and analyzed the data, drafted the original manuscript, and revised the article. ASW revised the article. JKC, DAZ, and BMM reviewed the article. GPC critically reviewed the article. ALC conceptualized the study.

    • 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.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.