Comaneci Device for Temporary Coiling Assistance for Treatment of Wide-Necked Aneurysms: Initial Case Series and Systematic Literature Review.

Abstract Background Coiling of wide-necked aneurysms requires high-density packing of coils within the aneurysm, which necessitates adequate microcatheter access and navigability. The Comaneci device (Rapid Medical), introduced in the US in 2019, is a retrievable stent that can be used as an adjunct to coiling of a wide-necked aneurysm without limiting flow. We present a case series and systematic review of use of this device. Methods All cases involving use of the device at our institute between May 1, 2019 and April 30, 2020 were reviewed. A comprehensive systematic review of the literature was conducted using PubMed and EMBASE and a review of eligible article bibliographies. Results Five patients underwent Comaneci-assisted wide-necked aneurysm coiling during the study period; 4 were treated via a radial artery approach and 1 via a femoral artery approach. Two of the 5 patients presented with subarachnoid hemorrhage: 1 had a ruptured posterior inferior cerebellar artery aneurysm (PICA) (Hunt-Hess V, Fischer 4); the other had a ruptured middle cerebral artery aneurysm (Hunt-Hess II, Fischer 1). Mean aneurysmal neck size was 4.4±0.8mm; mean aspect ratio was 1.2±0.3. Raymond-Roy 1 occlusion was achieved in all aneurysms except the PICA aneurysm. Systematic review and literature search identified 4 articles that found use of the Comaneci device to treat wide-necked aneurysms to be effective. Conclusions This tool can be used with transfemoral and transradial approaches, allowing for continued flow through the parent vessel during the coiling procedure while providing a scaffold for dense coiling of the aneurysm and its neck.