Paraophthalmic Internal Carotid Artery Aneurysm: Coil Occlusion Assisted by the Comaneci Device

Abstract

This 45-year-old female experienced an episode of severe headache. Diagnostic work-up including a clinical examination performed at the initially consulted hospital revealed a neurologically asymptomatic patient at the time of admission. CT showed no evidence of a subarachnoid hemorrhage (SAH) or other findings potentially causative for the episode of headache but did reveal a hyper dense rounded lesion located in the left-sided subarachnoid space involved in the paraophthalmic segment of the internal carotid artery (ICA). The diagnosis of a wide-necked paraophthalmic ICA aneurysm was confirmed by MRI including contrast enhanced angiographic imaging. The patient was then referred to the author’s institution for endovascular occlusion of the aneurysm. A diagnostic angiography confirmed the diagnosis of a wide-necked aneurysm at the paraophthalmic segment of the ICA. Further to the initial investigation, a small aneurysm originating directly at the ophthalmic artery was found.

The aneurysm was treated by coil occlusion assisted by a temporary neck-bridging device (Comaneci, Rapid Medical). This technique allows for a coil occlusion of wide-necked aneurysms, avoiding use of a permanent implant in the parent artery and therefore use of concomitant anti-aggregation. The difference in the neck-bridging remodeling technique compared to that of a compliant balloon is the avoidance of flow arrest during the expansion of the device in the parent artery (i.e., the Comaneci Device can be left deployed throughout the entire procedure without a need of repeated deflations). The procedure was carried out under general anesthesia without clinical or technical complication. The patient was discharged 2 days later in a neurologically asymptomatic condition. Follow-up angiography performed 3 months later revealed a stable and complete occlusion of the large aneurysm in the clinically unchanged asymptomatic patient. The main topic of this presentation is to demonstrate a novel technique for the endovascular treatment of wide-necked aneurysms, without placing a permanent implant in the parent artery, offering a promising approach particularly for acutely ruptured aneurysms.