scholarly journals Early Experience with Comaneci, a Newly FDA-Approved Controllable Assist Device for Wide-Necked Intracranial Aneurysm Coiling

2021 ◽  
pp. 1-8
Author(s):  
M. Asif Taqi ◽  
Eytan Raz ◽  
Anastasia Vechera ◽  
Maksim Shapiro ◽  
Rishi Gupta ◽  
...  
Keyword(s):  
Maximum Height ◽  
Maximum Width ◽  
Complete Occlusion ◽  
Unruptured Aneurysms ◽  
Aneurysm Neck ◽  
The Usa ◽  
Institutional Experience ◽  
Aneurysm Occlusion ◽  
The Mean ◽  
Antegrade Flow

<b><i>Background:</i></b> Comaneci (Rapid Medical) is a compliant, adjustable mesh that provides temporary scaffolding during coiling of wide-necked intracranial aneurysms (WNAs) that preserves antegrade flow. We report our early multi-institutional experience with the Comaneci device in the USA. <b><i>Method:</i></b> We reviewed all patients with WNAs that were treated using the Comaneci device for coil remodeling of ruptured and unruptured aneurysms at 4 institutions between July 2019 and May 2020. Clinical characteristics, angiographic variables, and endovascular results were assessed. <b><i>Results:</i></b> A total of 26 patients were included (18 women). The mean age was 62.7 years (range 44–81). Fifteen patients presented with ruptured aneurysms and 11 with unruptured aneurysms. The mean aneurysm neck width was 3.91 mm (range 1.9–6.5) with a mean dome-to-neck ratio of 1.57 (range 0.59–3.39). The mean maximum width was 5.80 mm (range 3.0–9.9) and the mean maximum height was 5.61 mm (range 2.0–11.8). Successful aneurysm occlusion was achieved in 25 of 26 patients. Complete occlusion was achieved in 16 patients, near-complete occlusion was observed in 9 patients, and 1 patient demonstrated residual filling. The mean time of device exposure was 24 min (range 8–76). No vasospasm was observed at the device location. Clot formation on the device was noted in 2 separate cases, but there were no clinical sequelae. There was 1 intraprocedural complication in a case that involved the simultaneous use of 2 Comaneci devices. <b><i>Conclusions:</i></b> Our initial experience shows that the Comaneci device is a promising and reliable tool that can safely support coil remodeling of WNAs.

scholarly journals Shell Growth Pattern and Percentage Flesh Yield of the West African Clam, Galatea paradoxa (Born, 1778) from Itu Creek, Niger Delta Nigeria

2020 ◽  
Vol 27 (2) ◽  
pp. 119-126
Author(s):  
V.F. Akinjogunla ◽  
R.O. Moruf
Keyword(s):  
Growth Pattern ◽  
Niger Delta ◽  
Shell Growth ◽  
Correlation Coefficients ◽  
Live Weight ◽  
Maximum Height ◽  
Maximum Width ◽  
Shell Weight ◽  
The Mean ◽  
Galatea Paradoxa

Shell Morphometry is a fundamental tool for the evaluation of phenotypic stocks. The shell growth pattern and percentage flesh yield of Galatea paradoxa from Itu Creek in Niger Delta were investigated using standard morphometric methods. The mean in centimeter (cm) of 9.71±0.09, 35.02±0.22, 23.21±0.12, 37.11±0.25, 29.31±0.16 and 7.32±0.04 were recorded for shell length, maximum width, maximum height, nacre length, nacre width and hinge length respectively. Mean live weight of 115.70±1.09 g, mean flesh weight of 37.91 ± 0.23g and mean shell weight of 66.82±0.97 g were recorded for this species. Galatea paradoxa showed negative allometric growth (b < 3) while the correlation coefficients (r) in all the shell variables were far below „1‟, indicating a week correlation between the parameters. About 19% of the live weight of the clam is made up of flesh by weight. Keywords: Bivalve, Clam, Shell dimension, Niger Delta.

scholarly journals Metal coverage ratio of pipeline embolization device for treatment of unruptured aneurysms: Reality check

2015 ◽  
Vol 22 (1) ◽  
pp. 42-48 ◽  
Author(s):  
Liang-Der Jou ◽  
Gouthami Chintalapani ◽  
Michel E Mawad
Keyword(s):  
Flow Diverter ◽  
Pipeline Embolization Device ◽  
Unruptured Aneurysms ◽  
Coverage Ratio ◽  
Reality Check ◽  
Local Mean ◽  
Aneurysm Occlusion ◽  
Occlusion Rate ◽  
The Mean ◽  
The Difference

Background and purpose The metal coverage ratio (MCR) of a flow diverter influences the intra-aneurysmal hemodynamics; a high MCR will occlude an aneurysm early, while a low MCR may delay aneurysm occlusion. The true MCR of a pipeline embolization device (PED) could be lower due to oversize, device deformation, or aneurysm location. In this study deviation of the true MCR from the nominal MCR is assessed and whether their difference affects aneurysm occlusion rate is determined. Methods A total of 40 consecutive patients, each of them treated by one PED for their aneurysms at the internal carotid artery (ICA), were retrospectively analyzed. The DynaCT images of these deployed PEDs were used to determine their true dimensions and estimate three MCRs (local, mean, and nominal). These data were compared in two groups of patients who had different aneurysm outcomes at six months. Results The difference in the local MCR between two groups is small, but statistically significant (24.5% vs 21.6%, p = 05). The local MCR is consistently lower than the nominal MCRs (23.2% vs 30.2%, p < 0.001); however, the difference between the mean and local MCRs is small (23.9% vs 23.2%). Conclusions An expectation that a PED can achieve a MCR of 30% may not be reasonable. Device oversize and deformation during deployment lower the local MCR by 5–7%. A lowered MCR affects the aneurysm occlusion rate at six months.

scholarly journals Techniques and long-term outcomes of cotton-clipping and cotton-augmentation strategies for management of cerebral aneurysms

2016 ◽  
Vol 125 (3) ◽  
pp. 720-729 ◽  
Author(s):  
Sam Safavi-Abbasi ◽  
Felix Moron ◽  
Hai Sun ◽  
Mark E. Oppenlander ◽  
M. Yashar S. Kalani ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Recurrence Rate ◽  
Aneurysm Rupture ◽  
Unruptured Aneurysms ◽  
Aneurysm Neck ◽  
Augmentation Strategies ◽  
Augmentation Techniques ◽  
The Mean ◽  
Clipping Technique

OBJECTIVE To address the challenges of microsurgically treating broad-based, frail, and otherwise complex aneurysms that are not amenable to direct clipping, alternative techniques have been developed. One such technique is to use cotton to augment clipping (“cotton-clipping” technique), which is also used to manage intraoperative aneurysm neck rupture, and another is to reinforce unclippable segments or remnants of aneurysm necks with cotton (“cotton-augmentation” technique). This study reviews the natural history of patients with aneurysms treated with cotton-clipping and cotton-augmentation techniques. METHODS The authors queried a database consisting of all patients with aneurysms treated at Barrow Neurological Institute in Phoenix, Arizona, between January 1, 2004, and December 31, 2014, to identify cases in which cotton-clipping or cotton-augmentation strategies had been used. Management was categorized as the cotton-clipping technique if cotton was used within the blades of the aneurysm clip and as the cotton-clipping technique if cotton was used to reinforce aneurysms or portions of the aneurysm that were unclippable due to the presence of perforators, atherosclerosis, or residual aneurysms. Data were reviewed to assess patient outcomes and annual rates of aneurysm recurrence or hemorrhage after the initial procedures were performed. RESULTS The authors identified 60 aneurysms treated with these techniques in 57 patients (18 patients with ruptured aneurysms and 39 patients with unruptured aneurysms) whose mean age was 53.1 years (median 55 years; range 24–72 years). Twenty-three aneurysms (11 cases of subarachnoid hemorrhage) were treated using cotton-clipping and 37 with cotton-augmentation techniques (7 cases of subarachnoid hemorrhage). In total, 18 patients presented with subarachnoid hemorrhage. The mean Glasgow Outcome Scale (GOS) score at the time of discharge was 4.4. At a mean follow-up of 60.9 ± 35.6 months (median 70 months; range 10–126 months), the mean GOS score at last follow-up was 4.8. The total number of patient follow-up years was 289.4. During the follow-up period, none of the cotton-clipped aneurysms increased in size, changed in configuration, or rebled. None of the patients experienced early rebleeding. The annual hemorrhage rate for aneurysms treated with cotton-augmentation was 0.52% and the recurrence rate was 1.03% per year. For all patients in the study, the overall risk of hemorrhage was 0.35% per year and the annual recurrence rate was 0.69%. CONCLUSIONS Cotton-clipping is an effective and durable treatment strategy for intraoperative aneurysm rupture and for management of broad-based aneurysms. Cotton-augmentation can be safely used to manage unclippable or partially clipped intracranial aneurysms and affords protection from early aneurysm re-rupture and a relatively low rate of late rehemorrhage.

scholarly journals Coiling of a recurrent broad-necked posterior communicating aneurysm incorporating a fetal cerebral artery: A technical case report

2015 ◽  
Vol 21 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Young-Joon Kim ◽  
Jung Ho Ko
Keyword(s):  
Case Report ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Posterior Cerebral Artery ◽  
Anterior Communicating Artery ◽  
Complete Occlusion ◽  
Aneurysm Neck ◽  
Aneurysm Occlusion ◽  
Contralateral Internal Carotid Artery

We describe a case of a right broad-necked posterior communicating artery (PcomA) aneurysm with a fetal posterior cerebral artery (PCA) incorporated in the aneurysm neck. We performed waffle cone stent-assisted coiling and achieved almost complete occlusion of the aneurysm. At 18-month follow-up angiography, the aneurysm was recanalized and further coiling was needed. The same waffle cone method of coiling might be expected to produce the same unsatisfactory results on follow-up, so we decided to use retrograde stent navigation and placement through the anterior communicating artery (AcomA) from the contralateral internal carotid artery (ICA) to the ipsilateral ICA and fetal PCA. The stent delivery microcatheter from the contralateral ICA could not be introduced in the AcomA. So 2 mg nimodipine was infused through the stent delivery microcatheter to the AcomA and the stent delivery microcatheter was passed through the AcomA easily and could be navigated to the ipsilateral A1, ICA, and to the fetal PCA. With this additional stent, the aneurysm was completely separated from the fetal PCA and ICA. Further coiling could be performed safely through the microcatheter in the ipsilateral ICA. The patient had stable aneurysm occlusion at the six-month follow up.

Regrowth of aneurysm sacs from residual neck following aneurysm clipping

1989 ◽  
Vol 70 (4) ◽  
pp. 556-560 ◽  
Author(s):  
Teresa Lin ◽  
Allan J. Fox ◽  
Charles G. Drake
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Recurrent Hemorrhage ◽  
Content Type ◽  
Complete Occlusion ◽  
Aneurysm Neck ◽  
Aneurysm Clipping ◽  
Long Period ◽  
Aneurysm Occlusion ◽  
Fine Print

✓ It is recognized that incomplet treatment of an aneurysm may result in recurrent hemorrhage with serious or fatal consequences. For this reason, patients treated at the authors' institution in whom a large portion of the aneurysm neck or sac remained after application of a clip or ligature have been subjected to reoperation. However, 1- to 2-mm residual necks seen in postoperative angiography have been thought to pose little risk. Some cases of aneurysms recurring from a narrow residual neck after clipping have been reported, and a few instances of recurrent aneurysm have been described after apparently complete occlusion of the neck (as observed angiographically or in the surgeon's judgment). In recent years, a surprising number of cases have been presented in which this seemingly unimportant remnant of the neck dilated over a long period to become a dangerous aneurysm. This finding stresses the importance of complete aneurysm occlusion and of postoperative angiography for the recognition of a residual aneurysm neck. This should be important not only in aneurysm clipping but also in the endovascular treatment of intracranial aneurysms with detachable balloons.

scholarly journals Angiographic Follow-up of Embolization Using Guglielmi Detachable Coils for Cerebral Aneurysms

2003 ◽  
Vol 9 (1_suppl) ◽  
pp. 47-50 ◽  
Author(s):  
Y. Nakai ◽  
M. Sonobe ◽  
K. Sugita ◽  
Y. Matsumaru
Keyword(s):  
Morphological Changes ◽  
Cerebral Aneurysms ◽  
Guglielmi Detachable Coils ◽  
Complete Occlusion ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Detachable Coils ◽  
Aneurysm Occlusion

The purpose of this study is to evaluate the mid or long-term angiographical stability of Guglielmi Detachable Coils (GDC) after embolization for cerebral aneurysms. Between march 1997 and november 2001, 164 aneurysms, including 116 ruptured and 48 unruptured aneurysms, were treated using GDC at Mito National Hospital. Cerebral angiograms over one month after embolization were obtained in 111 aneurysms, including 71 ruptured and 40 unruptured aneurysms. At the time of initial GDC embolization of the 71 ruptured aneurysms, complete occlusion was achieved in 31 aneurysms, neck remnant in 18 aneurysms, and body filling in 22 aneurysms. Morphological changes were observed in 26 aneurysms (37%) in follow-up. Progressive thrombosis was obtained in 12 out of 71 aneurysms, no changes were shown in 45, and recanalizations occurred in 14. In the initial embolization of the 40 unruptured aneurysms, complete occlusion was achieved in 15 aneurysms, neck remnant in five and body filling in 20 aneurysms respectively. Morphological changes were observed in 12 aneurysms (30%), in which 12 aneurysms showed progressive thrombosis and 28 aneurysms were unchanged. There were significant differences of the long-term angiographical stability between ruptured and unruptured aneurysms. Rigorous follow-up angiography is mandatory when complete aneurysm occlusion is not achieved in ruptured aneurysms.

Statins are not associated with short-term improved aneurysm healing in a rabbit model of unruptured aneurysms

2016 ◽  
Vol 9 (2) ◽  
pp. 200-203 ◽  
Author(s):  
Waleed Brinjikji ◽  
Ding Yong Hong ◽  
Daying Dai ◽  
Dana J Schroeder ◽  
David F Kallmes ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Rabbit Model ◽  
Control Group ◽  
Mesenchymal Progenitor Cells ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Platinum Coil ◽  
Aneurysm Occlusion ◽  
The Mean ◽  
And Control

BackgroundOwing to their anti-inflammatory effects and ability to stimulate production of extracellular matrix and chemotactic migration of mesenchymal progenitor cells, statins could potentially improve aneurysm healing after endovascular treatment.ObjectiveTo test the hypothesis that systemic administration of simvastatin would improve aneurysm healing in a rabbit model of unruptured intracranial aneurysms.MethodsExperimental aneurysms were created in female rabbits and were embolized with platinum coils. Six rabbits served as controls and six rabbits received oral administration of simvastatin. Digital subtraction angiography was used to evaluate stability after embolization. Subjects were euthanized 4 weeks after coil embolization. Histologic samples were examined with a grading system (0–12) based on neck and dome features. Aneurysm occlusion data were compared using a Student t test.ResultsNo significant differences in the mean aneurysm size were found between groups. No coil compaction occurred in either group. All aneurysms in both the statin and control groups showed stable occlusion. There were no significant differences in the histologic grade of occlusion in either group (statin group 2.6±0.8 vs control group 2.7±3.2, p=0.94).ConclusionsSystemic statin administration after platinum coil embolization of unruptured aneurysms in a rabbit model does not improve aneurysm occlusion rates at 4 weeks.

scholarly journals Solitaire AB Stent-Assisted Coiling of Wide-Necked Intracranial Aneurysms

Neurosurgery ◽  
2014 ◽  
Vol 75 (3) ◽  
pp. 215-219 ◽  
Author(s):  
Benjamin Gory ◽  
Joachim Klisch ◽  
Alain Bonafé ◽  
Charbel Mounayer ◽  
Remy Beaujeux ◽  
...  
Keyword(s):  
Prospective Study ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Complete Occlusion ◽  
Aneurysm Neck ◽  
Mean Width ◽  
Mean Diameter ◽  
The Mean ◽  
Wide Neck

Abstract BACKGROUND: Endovascular treatment of intracranial aneurysms can be technically difficult when the neck is wide. The Solitaire AB stent (Covidien, Irvine, California), the only fully retrieved stent, assists in the coiling of wide-neck intracranial aneurysms. OBJECTIVE: To evaluate the mid-term angiographic follow-up of wide-necked aneurysms treated with the Solitaire AB stent. METHODS: SOLARE (SOLitaire Aneurysm Remodeling) is a consecutive, prospective study conducted in 7 European centers. A core laboratory evaluated the postoperative and mid-term (6 month ± 15 days) angiographic results by using the Raymond classification Scale. Recanalization was defined as worsening, and progressive thrombosis was defined as improvement in the Raymond scale score. RESULTS: The mean width of the aneurysm sac was 7.5 mm, and the mean diameter of the aneurysm neck was 4.7 mm. Angiographic mid-term follow-up was obtained in 55 of 65 aneurysms (85.9%). Complete occlusion was achieved in 33 aneurysms (60%); a neck remnant was seen in 16 aneurysms (29.1%) and an aneurysm remnant in 6 aneurysms (10.9%). Of 55 aneurysms, recanalization was observed in 8 aneurysms (14.5%), and progressive thrombosis was observed in 17 aneurysms (30.9%). No bleeding or rebleeding was observed during the follow-up period. CONCLUSION: Stent-assisted coiling of wide-necked intracranial aneurysms was found to be safe and effective with the Solitaire AB stent at 6-month follow-up. Angiographic results improve with time due to progressive thrombosis of the aneurysm.

Y-configuration stenting for coiling of wide-neck bifurcation aneurysms using Low-profile Visualized Intraluminal Support Junior

2018 ◽  
Vol 11 (4) ◽  
pp. 400-404 ◽  
Author(s):  
Keun Young Park ◽  
Byung Moon Kim ◽  
Dong Joon Kim ◽  
Joonho Chung ◽  
Jae Whan Lee
Keyword(s):  
Internal Carotid ◽  
Anterior Communicating Artery ◽  
Complete Occlusion ◽  
Neck Size ◽  
Low Profile ◽  
Aneurysm Occlusion ◽  
The Mean ◽  
Procedural Success ◽  
Wide Neck

BackgroundLittle has been reported about the feasibility and durability of a Low-profile Visualized Intraluminal Support Junior (LVIS Jr) Y-stenting device for wide-neck bifurcation aneurysms.PurposeTo evaluate the feasibility and durability of LVIS Jr Y-stenting for coiling of unruptured wide-neck bifurcation aneurysms.MethodsWe identified patients in whom LVIS Jr Y-stenting was attempted for unruptured wide-neck bifurcation aneurysms from a prospectively maintained registry of a referral hospital. Procedural success rate, treatment-related morbidity, and clinical and angiographic outcomes were retrospectively assessed.ResultsLVIS Jr Y-stenting was attempted for a total of 21 aneurysms in 21 patients (mean age 60±8.9 years; M:F=6:15): nine basilar artery, six anterior communicating artery, four middle cerebral artery, one internal carotid artery, and one vertebrobasilar fenestration aneurysms. The mean dome and neck size were 7.9±2.7 mm and 5.7±1.8 mm, respectively. All attempts were successful. Treatment-related morbidity occurred in one individual with a modified Rankin Scale (mRS) score of 2. Immediate postprocedural angiograms showed complete occlusion in 15 (71.4%) and neck remnant in 6 (28.6%) patients. All 21 patients had good outcomes (mRS score 0–2) for a mean of 12 months' follow-up (range 6–27 months); mRS score 0 in 20 patients and mRS score 2 in one patient, respectively. Follow-up imaging over a mean of 11 months (range 6–18 months) was available in 18 patients (85.7%). All aneurysms showed complete occlusion at follow-up.ConclusionsLVIS Jr Y-stenting and coiling for wide-neck bifurcation aneurysms seems to be feasible with acceptable safety and to provide durable aneurysm occlusion for wide-neck bifurcation aneurysms.

Immediate post-operative aneurysm occlusion after endovascular treatment of intracranial aneurysms with coiling or balloon-assisted coiling in a prospective multicenter cohort of 1189 patients: Analysis of Recanalization after Endovascular Treatment of intracranial Aneurysm (ARETA) Study

2020 ◽  
pp. neurintsurg-2020-017012
Author(s):  
Laurent Pierot ◽  
Coralie Barbe ◽  
Denis Herbreteau ◽  
Jean-Yves Gauvrit ◽  
Anne-Christine Januel ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Endovascular Treatment ◽  
Complete Occlusion ◽  
Unruptured Aneurysms ◽  
Link Type ◽  
Narrow Neck ◽  
First Line Therapy ◽  
Grade Scale ◽  
Registration Number ◽  
Aneurysm Occlusion

BackgroundCoiling, including balloon-assisted coiling (BAC), is the first-line therapy for ruptured and unruptured aneurysms. Its efficacy can be clinically evaluated by bleeding/rebleeding rate after coiling, and anatomically evaluated by aneurysm occlusion post-procedure and during follow-up. We aimed to analyze immediate post-coiling aneurysm occlusion and associated factors within the Analysis of Recanalization after Endovascular Treatment of intracranial Aneurysm (ARETA) population.MethodsBetween December 2013 and May 2015, 16 neurointerventional departments prospectively enrolled participants treated for ruptured and unruptured aneurysms (ClinicalTrials.gov: NCT01942512). Participant demographics, aneurysm characteristics, and endovascular techniques were recorded. In patients with aneurysms treated by coiling or BAC, immediate post-operative aneurysm occlusion was independently evaluated by a core lab using a 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant.ResultsOf 1135 participants (age 53.8±12.8 years, 754 women (66.4%)), 1189 aneurysms were analyzed. Treatment modality was standard coiling in 645/1189 aneurysms (54.2%) and BAC in 544/1189 (45.8%). Immediate post-operative aneurysm occlusion was complete occlusion in 57.8%, neck remnant in 34.4%, and aneurysm remnant in 7.8%. Adequate occlusion (complete occlusion or neck remnant) was significantly more frequent in aneurysms with size <10 mm (93.1% vs 86.3%; OR 1.8, 95% CI 1.1 to 3.2; p=0.02) and in aneurysms with a narrow neck (95.8% vs 89.6%; OR 2.5, 95% CI 1.5 to 4.1; p=0.0004). Patients aged <70 years had significantly more adequate occlusion (92.7% vs 87.2%; OR 1.9, 95% CI 1.1 to 3.4; p=0.04).ConclusionsImmediately after aneurysm coiling, including BAC, adequate aneurysm occlusion was obtained in 92.2%. Age <70 years, aneurysm size <10 mm, and narrow neck were factors associated with adequate occlusion.Trial registration numberNCT01942512, http://www.clinicaltrials.gov.

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