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Endovascular Treatment of Wide-Necked Visceral Artery Aneurysms Using the Neurovascular Comaneci Neck-Bridging Device: A Technical Report

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Abstract

Introduction

Visceral and renal artery aneurysms (VRAAs) are an uncommon clinical entity but carry a risk of rupture with associated morbidity and mortality. The rupture risk is particularly high when the aneurysms are large, of unfavourable morphology or in the setting of pregnancy and perioperative period. Endovascular approaches are now first line in the treatment of VRAA, but conventional techniques may be ineffective in excluding aneurysms with unfavourable anatomy such as those with wide necks or at arterial bifurcation points. The neurovascular Comaneci neck-bridging device is used to temporarily cover the neck of intracranial aneurysms without occluding forward arterial flow during endovascular coiling. We report the novel use of the Comaneci neck-bridging device for the treatment of complex peripheral VRAAs.

Materials and Methods

We describe the treatment of two patients with renal and splenic artery aneurysms demonstrating unfavourable anatomic morphology for conventional endovascular approaches.

Results

In the first patient, the renal artery aneurysm was situated at the intrarenal bifurcation of the main renal artery in the setting of a solitary kidney. In the second patient, the splenic artery aneurysm was situated close to the splenic hilum at the distal splenic arterial bifurcation. The Comaneci neck-bridging device was successfully used in both cases to assist coil embolisation with visceral preservation.

Conclusions

The Comaneci neck-bridging device is potentially safe and effective for the treatment of peripheral VRAA with unfavourable anatomic characteristics that would have been deemed unsuitable for treatment using conventional techniques.

Level of Evidence

Level 4, Technical Report.

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Authors and Affiliations

  1. Interventional Radiology Service, Department of Radiology, Austin Hospital, Heidelberg, Melbourne, Australia

    Julian Maingard, Dinesh Ranatunga, Duncan Mark Brooks & Hamed Asadi

  2. Interventional Radiology Service, Department of Radiology, Beaumont Hospital, and Royal College of Surgeons in Ireland, Dublin, Ireland

    Hong Kuan Kok, Emma Phelan, Caitriona Logan, Michael J. Lee & Hamed Asadi

  3. Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia

    Ronil V. Chandra & Hamed Asadi

  4. Department of Imaging, Monash University, Melbourne, Australia

    Ronil V. Chandra & Hamed Asadi

  5. Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Australia

    Duncan Mark Brooks & Hamed Asadi

  6. School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia

    Hamed Asadi

  7. Department of Interventional Radiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Hong Kuan Kok

Authors
  1. Julian Maingard
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  2. Hong Kuan Kok
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  3. Emma Phelan
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  4. Caitriona Logan
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  8. Michael J. Lee
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  9. Hamed Asadi
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Correspondence to Julian Maingard.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Maingard, J., Kok, H.K., Phelan, E. et al. Endovascular Treatment of Wide-Necked Visceral Artery Aneurysms Using the Neurovascular Comaneci Neck-Bridging Device: A Technical Report. Cardiovasc Intervent Radiol 40, 1784–1791 (2017). https://doi.org/10.1007/s00270-017-1733-y

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  • DOI: https://doi.org/10.1007/s00270-017-1733-y

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