Acutely ruptured basilar artery bifurcation aneurysm, treated with simultaneous Cascade and Comaneci temporary-assisted coiling

Temporary stent-assisted coiling is an eligible approach for the treatment of acutely ruptured complex cerebral aneurysms. Improved material properties and industrial advances in braiding technology have led to the introduction of new stent-like devices to augment endovascular coil embolization. Such technology includes the Cascade and Comaneci neck-bridging devices. Both devices are manually controlled, non-occlusive and fully retrievable neck-bridging temporary implants. The braided nature and the ultra-thin wire, compliant structure of their bridging meshes helps maintain target vessel patency during coil embolization. In this video (video 1) we demonstrate the straightforward combination of two temporary neck-bridging devices for the embolization of an acutely ruptured aneurysm of the basilar artery. Technical success and complete embolization of the aneurysm were recorded at the final angiography. In this technical video we discuss the technical nuances of the Comaneci and Cascade coil embolization. Video 1 10.1136/neurintsurg-2020-016320.video01 6165910265001 BMJ Journals Video Player neurintsurg2020016320media1

[1]  P. Bhogal,et al.  The Cascade device – In vitro tests to assess coil protrusion into the parent vessel , 2020, Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences.

[2]  C. Bleise,et al.  The Contour—Early Human Experience of a Novel Aneurysm Occlusion Device , 2020, Clinical Neuroradiology.

[3]  P. Bhogal,et al.  Flow-T stenting with the Silk Vista Baby and Baby Leo stents for bifurcation aneurysms – A novel endovascular technique , 2020, Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences.

[4]  P. Lylyk,et al.  The p48_HPC antithrombogenic flow diverter: initial human experience using single antiplatelet therapy , 2019, The Journal of international medical research.

[5]  R. Raychev,et al.  Early clinical experience with Cascade: a novel temporary neck bridging device for embolization of intracranial aneurysms , 2019, Journal of NeuroInterventional Surgery.

[6]  S. Sirakov,et al.  Early experience with a temporary bridging device (Comaneci) in the endovascular treatment of ruptured wide neck aneurysms , 2018, Journal of NeuroInterventional Surgery.

[7]  Huijian Ge,et al.  The role of endovascular treatment in unruptured basilar tip aneurysms , 2017, Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences.

[8]  O. Ganslandt,et al.  Use of the pCONus as an adjunct to coil embolization of acutely ruptured aneurysms , 2016, Journal of NeuroInterventional Surgery.

[9]  A. Molyneux.  International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial , 2002, The Lancet.

[10]  W. O'Fallon,et al.  The poor prognosis of ruptured intracranial aneurysms of the posterior circulation. , 1995, Journal of neurosurgery.