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Augmentation of Flow Diverter Vessel Wall Apposition Using the Comaneci Device in Distal Circulation: Experience in
Jessica K Campos1, Jonathan C Collard de Beaufort2, Fahad J Laghari3
1Department of Neurosurgery, University of California, Irvine, Orange, USA.
Background:
Flow diversion (FD) requires perfect vessel wall apposition to optimize aneurysm occlusion rates and minimize complications.
Objective:
To elucidate the safety of an off-label technique using the Comaneci device for augmenting vessel wall apposition of distally deployed flow-diverting stents.
Methods:
Over a 20-month period, all FD cases for the treatment of aneurysms beyond the internal carotid artery terminus performed by the senior author were reviewed. Patient demographics, case characteristics, and procedural outcomes were collected and analyzed for cases involving both distal aneurysms and the use of the Comaneci device to augment vessel wall apposition.
Results:
Of 58 FD cases of distal aneurysms, the Comaneci device was required for vessel wall apposition in 16 cases (27%). Of these cases, the average patient age was 68.8 ± 8.4 years, and 13 (81%) were female. Average aneurysm size was 3.3 ± 1.1 mm. Comaneci device deployment and retrieval was successful in all (100%) cases. Procedures had an average fluoroscopy time of 38 ± 20.9 minutes, average contrast use of 37.9 ± 9.9 mL, and average radiation exposure of 1182 ± 458.3 mGy.
Conclusion:
This study demonstrates the safety and feasibility of a previously described technique for augmenting stent stenosis in proximal anterior circulation applied in distal anterior circulation aneurysms.Clinical ImpactIncomplete vessel wall apposition of flow-diverting stents increases the risk of thromboembolic complications, in-stent stenosis, and treatment failure. In the distal circulation, techniques for improving apposition are limited due to anatomical tortuosity and vessel size. This series demonstrates the use of the Comaneci device as a safe and effective method for augmenting flow diverter apposition beyond the internal carotid artery terminus. This technique maintains endoluminal flow throughout remodeling, requires no exchange of the existing 0.027" microcatheter, and minimizes device burden, making it an efficient technique for clinicians.
