Multi-center clinical experience in 15 cases with the innovative CE-marked Cascade Net device was highlighted in the January 2020 Journal of Neurosurgery article, “Early experience with a novel net temporary bridging device (Cascade) to assist endovascular coil embolization of intracranial aneurysms” by Dr Alejandro Tomasello et al*.
The paper demonstrates that the non-occlusive Cascade device was “safe and effective for assisting endovascular coil embolization”, representing “a further technical refinement of the remodeling technique that may increase the success rate of the procedure and expand the application of this technique in small aneurysms with complex anatomy, with better control in technically challenging cases.” Device implantation was successful in all cases with no evidence of thromboembolism, rupture or other procedure complications.
These results build on existing data which has shown the benefit of using adjunctive devices in coil embolization to “provide coil stabilization and avoid loop herniation” as an “essential” step in treating “complex anatomies, such as wide-necked aneurysms.” One solution, balloon catheter assisted remodeling technique (BRT), has shown better post-operative occlusion rates than standard care. However, these devices result in a temporary blood flow arrest in the parent artery, which creates an unnecessary time constraint during the procedure.
Expanding on the benefits of BRT during coil embolization, the innovative Cascade remodeling net device (Perflow Medical) was developed to allow for continued blood flow during coil embolization while offering an enhanced experience with radiopacity, flexibility, rigidity and predictability.
In the underlying study, total average procedure time was 30 minutes – similar to the same procedure using other devices – leading the authors to conclude that the Cascade device allows “lessening time pressure to the neuro-interventionalist related to the risk of ischemia and thromboembolism” and “does not increase the overall procedure time.”
The responsive braided architecture of the Cascade offers optimal compliance with “complex vessel anatomy” in all anatomies studied. With a maximum cell size of 0.3 mm² – smaller than the diameter of currently available coils – the Cascade is designed to prevent entanglement with the coil during placement. A total of 4 models are commercially available, depending on the vessel diameter and required device length. Recommended sizing per vessel diameters are as follows: 2 - 4 mm M model, 4-6 mm L model. Both models are compatible with a 0.021-inch microcatheter and have a distal tip wire. The Cascade Agile, with a shorter net length of 21 mm, was recently launched for use in distal aneurysms with tortuous anatomy.
An ergonomic handle allows the operator to adjust the diameter and length of the Cascade as well as to adapt “the radial force in order to achieve optimal aneurysm neck coverage.” The adjustable radial force allows for a “dynamic relationship between the intrasaccular microcatheter and the coils”, and permits reorientation of the microcatheter.
In conclusion, the study finds the Cascade device to be “safe and effective for assisting endovascular coil embolization of intracranial aneurysms” without changing the procedural complication rate. The company recently reported that the Cascade device is used in several medical centers throughout Europe.
CASCADETM Non-Occlusive Remodeling Net, Perflow Medical
*Alejandro Tomasello, David Hernandez, Laura Ludovica Gramegna, Sonia Aixut, Roger Barranco Pons, Olav Jansen, Michal Zawadzki, Antonio Lopez-Rueda, Carmen Parra-Fariñas, Carlos Piñana, Lavinia Dinia, Fuat Arikan and Alex Rovira. Early experience with a novel net temporary bridging device (Cascade) to assist endovascular coil embolization of intracranial aneurysms. J Neurosurg. 2020 Jan 24:1-9. doi: 10.3171/2019.11.JNS192477. [Epub ahead of print]
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