Use of a neck-bridging device for endovascular coiling of a wide-necked middle cerebral artery aneurysm

Endovascular treatment of wide-necked bifurcation intracranial aneurysms is technically challenging, often requiring adjunctive devices such as stents or balloons to maintain coil mass within the aneurysm sac. Comaneci is a radiopaque embolization-assist device that can be temporarily deployed in the parent artery across the aneurysm neck without arresting blood flow for remodeling of coil mass. It is removed once coiling without luminal coil protrusion is achieved. In this video, we demonstrate use of the device for coiling of a wide-necked right middle cerebral artery (MCA) aneurysm in a 54-year-old woman. This patient presented with an unruptured MCA bifurcation aneurysm that showed growth on serial imaging. She wanted to avoid dual antiplatelet therapy, precluding the use of stent-assisted coiling. After detailed discussion with the patient, we proceeded with Comaneci-assisted coiling. Satisfactory aneurysm coiling was achieved without periprocedural complication. In the video, we further discuss potential indications and advantages of the device.