How to use the nautilus intrasaccular system

Abstract

The Nautilus intrasaccular system (EndoStream Medical, Israel) is a spiral-shaped neck-bridging endovascular device designed to support coiling of intracranial aneurysms [1–3]. It is deployed into the aneurysm sac through a 0.0165” or 0.017” microcatheter. Coils are delivered via a second microcatheter passed through the struts of the device. The system is available in 4–7-mm sizes and is entirely radio-opaque. It is mechanically detached and fully resheathable. Constructed from a nitinol wire with a platinum-based coil sleeve, it lacks a proximal marker. It has the lowest profile of current intrasaccular devices but a limited size range. Antiplatelet therapy is not mandatory. Limited published series and post-market data suggest high occlusion rates with low complication rates. The device may be particularly suitable for ruptured wide-necked aneurysms. This technical video discusses the device with the aid of two illustrative cases.

Keywords

Aneurysm intrasaccular device

Footnotes

ORCID iD

Jeremy Lynch

Ethical approval

The study was conducted in accordance with the ethical standards of our institution. Given the retrospective nature of the study, the need for informed consent was waived. Patient data confidentiality was strictly maintained.

Author contributions

JL, FM, JM, and TP contributed to the conception or design of the work, as well as the acquisition, analysis, or interpretation of data.

ML, MS, KP, SL, TP, and SS critically revised it and gave final approval of the version to be published.

All individuals listed as authors agree that they have met the criteria for authorship and agree to the conclusions. They agree to be accountable for all aspects of the work, ensuring its integrity and accuracy.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: This research received no external funding and was conducted and written without the financial support of any grants or institutional resources. TP declares consulting and proctoring agreement with Medtronic, Stryker, Balt, and Cerenovus. JL declares consulting agreement with Medtronic, Stryker, and Cerenovus. FM declares consulting agreement and payment for lectures/honoraria with Microvention, Stryker, Balt, Penumbra, and Endostream. JM declares consulting agreement with Kaneka.

Supplemental material

Supplemental material for this article is available online.

References

Sirakov

Bhogal

Sirakova

, et al. Endovascular treatment of wide-necked intracranial aneurysms using the nautilus intrasaccular system: initial case series of 41 patients at a single center. J Neurointerv Surg 2023; 15: 989–994.

Sirakov

Bhogal

Sirakova

, et al. Intrasaccular neck-bridging: a technical note on nautilus-assisted coiling of wide-necked cerebral aneurysms. Feasibility study, immediate and early angiographic results. Interv Neuroradiol 2022; 28: 746–755.

Treatment of Ruptured and Unruptured Wide-Neck Aneurysms With Nautilus™ Device Assisted Occlusion (TORNADO). Clinicaltrials.gov NCT04963933.

Supplementary Material

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