Avenir Mega
LMR Feedback Form
Case Information
Physician Name
*
Institution
*
Specialty
Case Date
*
Case Type
Unruptured Aneurysm
Ruptured Aneurysm
Fistula
Vessel Sac.
Other
If Other, specify
Lesion Location
Lesion Dimensions (mm)
Neck Dimensions (mm)
Products Used
Mega Coil SKU(s) Used
Other Coils Used
Microcatheter
Intermediate Catheter
Performance compared to currently preferred XL/18-Coil
Performance Rating
Sizes Available
Much Worse
1
2
3
4
5
Much Better
Much Worse
Much Better
Prep and Introduction
Much Worse
1
2
3
4
5
Much Better
Much Worse
Much Better
Delivery Feel
Much Worse
1
2
3
4
5
Much Better
Much Worse
Much Better
Deployment Ease
Much Worse
1
2
3
4
5
Much Better
Much Worse
Much Better
Frame Stability
Much Worse
1
2
3
4
5
Much Better
Much Worse
Much Better
Frame Uniformity
Much Worse
1
2
3
4
5
Much Better
Much Worse
Much Better
Detachment Ease
Much Worse
1
2
3
4
5
Much Better
Much Worse
Much Better
If answering 1-2, why?
Outcome
Did All Avenir Coils Deploy Successfully?
Yes
No
Did All Avenir Coils Detach Successfully?
Yes
No
Comments
Is this a product complaint?
Yes
No
If yes, will product be returned?
Yes
No
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