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Ho JK, Kee TP, Lee W. Endovascular treatment of wide-neck bifurcation aneurysms using pCONUS2 HPC bridging device with single antiplatelet: A Case Series. Medicine (Baltimore) 2024; 103:e37873. [PMID: 38640309 PMCID: PMC11030005 DOI: 10.1097/md.0000000000037873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/04/2024] [Accepted: 03/21/2024] [Indexed: 04/21/2024] Open
Abstract
RATIONALE Wide neck bifurcation aneurysms (WNBA) are technically challenging for both surgical and endovascular treatments. Endovascular treatment for WNBA often requires dual antiplatelet therapy (DAPT) post stent insertion. Novel devices such as the pCONUS2 HPC neck bridging device have an HPC coating which reduces the device thrombogenicity. This theoretically allows for use of single antiplatelet therapy (SAPT), which would be advantageous, particularly in treating ruptured aneurysms. This case series aims to evaluate the safety of SAPT regimen only post stent insertion, by presenting our center early clinical experience in using pCONUS2 HPC neck bridging device in patients that are not suitable for DAPT. PATIENT CONCERNS We report the cases of 3 patients (2 females, 1 male; range: 64-71 years old) who underwent coil embolization for WNBA using the pCONUS2 HPC device (2 unruptured WNBA, and 1 ruptured WNBA). As all 3 patients were allergic to Aspirin, they could only be started on SAPT post endovascular therapy. DIAGNOSIS All 3 patients were diagnosed with WNBA on angiographic studies. Patient 1 had an unruptured left middle cerebral artery aneurysm; Patient 2 had a ruptured basilar tip aneurysm; Patient 3 had an unruptured anterior communicating artery (ACOM) aneurysm. INTERVENTIONS All 3 WNBA were treated with pCONUS2 HPC neck bridging device. OUTCOMES There were no immediate complications. The immediate angiographic result of aneurysm treatment in Patient 1 and Patient 2 demonstrated incomplete occlusions, with delayed complete occlusion of aneurysm in Patient 1 and growth of aneurysmal neck in Patient 2 on follow-up angiograms (range: 6-9 months). No major thrombo-embolic or hemorrhagic complications in the first 2 patients. For Patient 3, the immediate angiographic result of the treated aneurysm demonstrated complete occlusion. However, the patient readmitted 11 days post procedure with cerebral infarction, scoring 5 on the modified Rankin scale on discharge. LESSONS pCONUS2 HPC as a neck bridging device in treating WNBA has yet to be shown superior to traditional techniques and devices. The theoretical advantage of HPC coating reducing its thrombogenicity requiring only SAPT is yet to be proven safe in clinical practice.
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Affiliation(s)
- Jun Kiat Ho
- Department of Neuroradiology, National Neuroscience Institute, Singapore, Singapore
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Santos-Franco JA, Cruz-Argüelles CA, Abrego-Salinas AA, Casas-Martínez MR, DeFont-Reaulx Rojas E. [Brain aneurysms treatment with pCONus2 device. Initial experience at IMSS]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:265-273. [PMID: 37216405 PMCID: PMC10437233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/08/2022] [Indexed: 05/24/2023]
Abstract
Background pCONus2 device has been used in some countries as coadyuvant in the treatment of wide-neck bifurcation aneurysms with coils. Objective To present the first series of brain aneurysms treated with pCONus2 in the Mexican Institute for Social Security (IMSS). Material and methods We retrospectively present the first 13 aneurysms treated from October 2019 to February 2022 with pCONus2 device at a third level hospital. Results 6 aneurysms located at anterior communicating artery, 3 at middle cerebral artery bifurcation, 2 at internal carotid artery bifurcatión, and 2 at the tip of basilar artery were treated. Device deployment was performed without complications and it was possible to embolize aneurysms with coils in 12 patients (92%), while on an internal carotid bifurcation aneurysm (8%) there was an incident of a pCONus2 petal migration toward vascular lumen caused by coils mesh pressure, situation that was solved by placing an nitinol self-expandable microstent. In 7 cases (54%) we performed coiling technique after microcatheter passage through pCONus2, while in 6 cases (46%) we used the jailing technique without complications. Conclusions pCONus2 is a useful device for wide-neck bifurcation aneurysms embolization. In Mexico our experience is yet limited; however, the first cases have been successful. Furthermore, we showed the first cases treated using jailing technique. Much more cases are required in order to carry out a statistically conclusive analysis and to establish the effectiveness and safety of the device.
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Affiliation(s)
- Jorge Arturo Santos-Franco
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Departamento de Neurocirugía y Terapia Endovascular Neurológica. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Carlos Antonio Cruz-Argüelles
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Departamento de Neurocirugía y Terapia Endovascular Neurológica. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Adrián Alejandro Abrego-Salinas
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Departamento de Neurocirugía y Terapia Endovascular Neurológica. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Martín Roberto Casas-Martínez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Departamento de Neurocirugía y Terapia Endovascular Neurológica. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
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Morales-Caba L, Lylyk I, Vázquez-Añón V, Bleise C, Scrivano E, Perez N, Lylyk PN, Lundquist J, Bhogal P, Lylyk P. The pCONUS2 and pCONUS2 HPC Neck Bridging Devices : Results from an International Multicenter Retrospective Study. Clin Neuroradiol 2023; 33:129-136. [PMID: 35819477 PMCID: PMC10014770 DOI: 10.1007/s00062-022-01191-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 06/16/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Bifurcation aneurysms represent an ongoing endovascular challenge with a variety of techniques and devices designed to address them. We present our multicenter series of the pCONUS2 and pCONUS2 HPC devices when treating bifurcation aneurysms. METHODS We performed a retrospective review of our prospectively maintained databases at 3 tertiary neurointerventional centers to identify all patients who underwent coil embolization with the pCONUS2 or pCONUS2 HPC device between February 2015 and August 2021. We recorded baseline demographics, aneurysm data, complications, immediate and delayed angiographic results. RESULTS We identified 55 patients with 56 aneurysms, median age 63 years (range 42-78 years), 67.3% female (n = 37). The commonest aneurysm location was the MCA bifurcation (n = 40, 71.4%). Average dome height was 8.9 ± 4.2 mm (range 3.2-21.5 mm), average neck width 6.4 ± 2.5 mm (range 2.6-14 mm), and average aspect ratio 1.3 ± 0.6 (range 0.5-3.3). The pCONUS2 was used in 64.3% and the pCONUS2 HPC in 35.7%. The procedural technical success rate was 98.2%. Intraoperative complications occurred in 5 cases (8.9%), 4 of which were related to the coils with partial thrombus formation on the pCONUS2 HPC seen in 1 case that was resolved with heparin. In relation to the procedure and treatment of the aneurysm the overall permanent morbidity was 1.8% (n = 1/55) and mortality 0%. Delayed angiographic follow-up (48 aneurysms) at median 12 months postprocedure (range 3-36 months) demonstrated adequate occlusion of 83.4% of aneurysms. CONCLUSION The pCONUS2 and pCONUS2 HPC devices carry a high technical success rate, low complication and retreatment rate, and good rates of adequate occlusion. Larger prospective confirmatory studies are required.
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Affiliation(s)
- L Morales-Caba
- Department of Neuroradiology, Hospital Universitari i Politècnic La Fe, València, Spain
- Department of Radiology, Hospital Universitari La Ribera, Alzira, Spain
| | - I Lylyk
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - V Vázquez-Añón
- Department of Neuroradiology, Hospital Universitari i Politècnic La Fe, València, Spain
- Department of Radiology, Hospital Universitari La Ribera, Alzira, Spain
| | - C Bleise
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - E Scrivano
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - N Perez
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - P N Lylyk
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - J Lundquist
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - P Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, Barts NHS Trust, Whitechapel Road, E1 1BB, London, UK.
| | - P Lylyk
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
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Wodarg F, Ozpeynirci Y, Hensler J, Jansen O, Liebig T. Contour-Assisted coiling with jailed microcatheter May result in better occlusion (CoCoJaMBO) in wide-necked intracranial aneurysms: Proof of principle and immediate angiographic results. Interv Neuroradiol 2023; 29:79-87. [PMID: 35014885 PMCID: PMC9893242 DOI: 10.1177/15910199211069782] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Wide-necked bifurcation aneurysms, partially thrombosed, and recurrences of large and giant aneurysms are challenging to treat. We report our preliminary experience with a Contour-assisted coiling technique and discuss the periprocedural safety, feasibility, and effectiveness of the approach. METHODS We retrospectively reviewed consecutive patients who received endovascular treatment for intracranial aneurysms with an intra-aneurysmal flow disruptor (Contour) at two neurovascular centres between October 2018 and December 2020 and identified patients treated with a combination of Contour and platinum coils. Clinical and procedural data were recorded. RESULTS For this analysis, 8 patients (5 female) aged 60.1 ± 9.2 years on average were identified. Three of 8 aneurysms were associated with previous acute subarachnoid hemorrhage (SAH). The mean average dome height was 12.8 ± 7.6 mm, mean maximum dome width 10.3 ± 5.4 mm, and neck width 5.5 ± 2.5 mm. The mean dome-to-neck ratio was 1.9 ± 1.0. Immediate complete occlusion of the aneurysm was seen in 5 of 8 cases. In one SAH patient, a parent vessel was temporarily occluded but could be reopened rapidly. One device detached prematurely without any sequelae. No other procedural adverse events were recorded. CONCLUSION From this initial experience, Contour with adjunctive coiling is a safe and technically feasible method for endovascular treatment of large, wide-necked, partially thrombosed, recurrent, or ruptured bifurcation aneurysms. Further studies with larger numbers of patients and longer follow-up are needed to confirm our results.
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Affiliation(s)
- Fritz Wodarg
- Department of Radiology and Neuroradiology, University Hospital
Schleswig-Holstein, Campus Kiel, Christian-Albrechts University, Germany
| | - Yigit Ozpeynirci
- Institute of Neuroradiology, LMU-University Hospital,
Ludwig-Maximilians-University, Munich, Germany
| | - Johannes Hensler
- Department of Radiology and Neuroradiology, University Hospital
Schleswig-Holstein, Campus Kiel, Christian-Albrechts University, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Hospital
Schleswig-Holstein, Campus Kiel, Christian-Albrechts University, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, LMU-University Hospital,
Ludwig-Maximilians-University, Munich, Germany
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Mascitelli JR, Lawton MT, Hendricks BK, Hardigan TA, Yoon JS, Yaeger KA, Kellner CP, De Leacy RA, Fifi JT, Bederson JB, Albuquerque FC, Ducruet AF, Birnbaum LA, Caron JLR, Rodriguez P, Mocco J. Endovascular Therapy Versus Microsurgical Clipping of Ruptured Wide Neck Aneurysms (EVERRUN Registry): a multicenter, prospective propensity score analysis. J Neurosurg 2022; 137:87-94. [PMID: 34740187 DOI: 10.3171/2021.7.jns211323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Randomized controlled trials have demonstrated the superiority of endovascular therapy (EVT) compared to microsurgery (MS) for ruptured aneurysms suitable for treatment or when therapy is broadly offered to all presenting aneurysms; however, wide neck aneurysms (WNAs) are a challenging subset that require more advanced techniques and warrant further investigation. Herein, the authors sought to investigate a prospective, multicenter WNA registry using rigorous outcome assessments and compare EVT and MS using propensity score analysis (PSA). METHODS Untreated, ruptured, saccular WNAs were included in the analysis. A WNA was defined as having a neck ≥ 4 mm or a dome/neck ratio (DNR) < 2. The primary outcome was the modified Rankin Scale (mRS) score at 1 year posttreatment, as assessed by blinded research nurses (good outcome: mRS scores 0-2) and compared using PSA. RESULTS The analysis included 87 ruptured aneurysms: 55 in the EVT cohort and 32 in the MS cohort. Demographics were similar in the two cohorts, including Hunt and Hess grade (p = 0.144) and modified Fisher grade (p = 0.475). WNA type inclusion criteria were similar in the two cohorts, with the most common type having a DNR < 2 (EVT 60.0% vs MS 62.5%). More anterior communicating artery aneurysms (27.3% vs 18.8%) and posterior circulation aneurysms (18.2% vs 0.0%) were treated with EVT, whereas more middle cerebral artery aneurysms were treated with MS (34.4% vs 18.2%, p = 0.025). Within the EVT cohort, 43.6% underwent stand-alone coiling, 50.9% balloon-assisted coiling, 3.6% stent-assisted coiling, and 1.8% flow diversion. The 1-year mRS score was assessed in 81 patients (93.1%), and the primary outcome demonstrated no increased risk for a poor outcome with MS compared to EVT (OR 0.43, 95% CI 0.13-1.45, p = 0.177). The durability of MS was higher, as evidenced by retreatment rates of 12.7% and 0% for EVT and MS, respectively (p = 0.04). CONCLUSIONS EVT and MS had similar clinical outcomes at 1 year following ruptured WNA treatment. Because of their challenging anatomy, WNAs may represent a population in which EVT's previously demonstrated superiority for ruptured aneurysm treatment is less relevant. Further investigation into the treatment of ruptured WNAs is warranted.
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Affiliation(s)
- Justin R Mascitelli
- 1Department of Neurosurgery, University of Texas Health Science Center at San Antonio, Texas
| | - Michael T Lawton
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Trevor A Hardigan
- 3Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York; and
| | - James S Yoon
- 4Yale School of Medicine, New Haven, Connecticut
| | - Kurt A Yaeger
- 3Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York; and
| | - Christopher P Kellner
- 3Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York; and
| | - Reade A De Leacy
- 3Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York; and
| | - Johanna T Fifi
- 3Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York; and
| | - Joshua B Bederson
- 3Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York; and
| | | | - Andrew F Ducruet
- 2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Lee A Birnbaum
- 1Department of Neurosurgery, University of Texas Health Science Center at San Antonio, Texas
| | - Jean Louis R Caron
- 1Department of Neurosurgery, University of Texas Health Science Center at San Antonio, Texas
| | - Pavel Rodriguez
- 1Department of Neurosurgery, University of Texas Health Science Center at San Antonio, Texas
| | - J Mocco
- 3Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York, New York; and
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Kim MJ, Chung J, Park KY, Kim YB, Kim DJ, Kim BM, Lee JW. Endovascular treatment for large (> 10 mm) basilar tip aneurysms: a retrospective case series. Acta Neurochir (Wien) 2022; 164:1239-1245. [PMID: 35262793 DOI: 10.1007/s00701-022-05175-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/23/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To report the long-term clinical and angiographic outcomes of the endovascular treatment of large/giant basilar tip aneurysms (BTAs) in our institutions. METHODS We retrospectively reviewed cases of BTA larger than 10 mm that received endovascular treatment between January 2009 and December 2019. Data on the demographic and clinical characteristics and radiologic severity were obtained from the patients' medical records. The collected clinical follow-up data included neurological evaluation. Magnetic resonance angiography (MRA) was performed 6 to 12 months after the procedure, followed by once every 1 to 2 years as needed. RESULTS A total of 12 patients with BTA were included in this study. The median age was 60.08 years (27-80 years), and the mean clinical follow-up was 66.78 months (19.00-142.87 months). Almost half of the patients presented with unruptured BTAs (58.33%, n = 7). The median maximum aneurysm diameter was 13.00 mm (10.46-20.90 mm) and the mean neck size was 8.34 mm (4.82-13.04 mm). A Modified Raymond Roy Classification (MRRC1) of 1 or 2 was observed in 66.67% of the patients (n = 8) immediately after the first procedure. Procedural morbidity and mortality were 33.33% and 8.33%, respectively. Major recanalization occurred in two patients, one of whom underwent additional coiling with the other being merely observed due to older age. CONCLUSION It is very difficult to cure a large BTA completely at once and recanalization occurred often after endovascular treatment. Conducting long-term follow-up studies at short intervals is warranted, as well as improving existing treatment methods and developing new approaches.
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Affiliation(s)
- Min Jeoung Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joonho Chung
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Keun Young Park
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Bae Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Joon Kim
- Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Moon Kim
- Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Whan Lee
- Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, Republic of Korea
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Results of the pToWin Study: Using the pCONUS Device for the Treatment of Wide-Neck Intracranial Aneurysms. J Clin Med 2022; 11:jcm11030884. [PMID: 35160333 PMCID: PMC8836830 DOI: 10.3390/jcm11030884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/03/2022] Open
Abstract
Coil embolization has become a well-established option for the treatment of intracranial aneurysms. Yet, wide-neck bifurcation aneurysms (WNBAs) remain a challenge. The pCONUS is the first generation of a stent-like implant for the bridging of WNBAs to enable coiling. The pToWin study was a prospective, single-arm, multicenter study conducted to analyze the safety and efficacy of the pCONUS in the treatment of WNBAs. The primary effectiveness endpoint was the rate of adequate occlusion of the aneurysm at 3–6 and 7–12 months. The primary safety endpoint was the occurrence of major ipsilateral stroke or neurological death during the follow-up. A total of 115 patients were included. Aneurysm locations were the middle cerebral artery in 52 (45.2%), the anterior communicating artery in 35 (30.4%), the basilar artery in 23 (20%), the internal carotid artery terminus in three (2.6%), and the pericallosal artery in two (1.7%) patients. Treatment was successfully performed in all but one patient. The morbi-mortality rate was 1.9% and 2.3% at 3–6 and 7–12 months, respectively. Of the aneurysms, 75.0% and 65.6% showed adequate occlusion at 3–6 and 7–12 months, respectively. pCONUS offers a safe and reasonably effective treatment of WNBAs, demonstrated by acceptable adequate aneurysm occlusion and low rates of adverse neurologic events.
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De Beule T, Boulanger T, Heye S, van Rooij WJ, van Zwam W, Stockx L. The Woven EndoBridge for unruptured intracranial aneurysms: Results in 95 aneurysms from a single center. Interv Neuroradiol 2021; 27:594-601. [PMID: 33745363 PMCID: PMC8493345 DOI: 10.1177/15910199211003428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/10/2021] [Accepted: 02/19/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND PURPOSE The Woven EndoBridge (WEB) is an intrasaccular flowdisruptor that is increasingly used for the treatment of (wide-necked) aneurysms. We present our experience with the WEB for unruptured aneurysms. MATERIALS AND METHODS Between April 2014 and August 2019, 93 patients with 95 unruptured aneurysms were primarily treated with the WEB. There were 69 women and 24 men, mean age 61 years (median 58, range 37-80). RESULTS Of 95 aneurysms, 86 had been discovered incidentally, 3 were symptomatic and 6 were additional to another ruptured aneurysm. Location was anterior communicating artery 33, middle cerebral artery 29, basilar tip 19, carotid tip 8, posterior communicating artery 4, posterior inferior cerebellar artery 1, superior cerebellar artery 1. Mean aneurysm size was 6 mm (median 6, range 3-13 mm).In one aneurysm additional coils were used and in another, a stent was placed. There was one procedural rupture without clinical sequelae. There were two thrombo-embolic complications leading to permanent deficit in one patient (mRS 2). Morbidity rate was 1.0% (1 of 93, 95%CI 0.01-6.5%) and mortality was 0% (0 of 93, 95%CI 0.0-4.8%). Angiographic follow-up at six months was available in 85 patients with 87 aneurysms (91%). Of 87 aneurysms, 68 (78%) were completely occluded, 14 (16%) had a neck remnant and 5 were incompletely occluded. Four aneurysms were retreated. Retreatment rate was 4.5% (4 of 87, 95%CI 1.7-13.6%). CONCLUSION WEB treatment of unruptured aneurysms is safe and effective. Additional devices are needed only rarely and retreatment at follow-up is infrequent.
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Affiliation(s)
- Tom De Beule
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Sam Heye
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Wim van Zwam
- Department of Radiology, Maastricht Universiteit Medisch Centrum, Maastricht, the Netherlands
| | - Luc Stockx
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
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Haj A, Schmidt NO, Wendl C, Schebesch KM. Massively calcified aneurysm of the anterior communicating artery: an unsuccessful clipping attempt followed by successful pCONus2-assisted coil occlusion. J Surg Case Rep 2021; 2021:rjab107. [PMID: 33927853 PMCID: PMC8055223 DOI: 10.1093/jscr/rjab107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/25/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022] Open
Abstract
We report the unique case of a 67-year-old female patient with an incidentally discovered massively calcified aneurysm of the anterior communicating artery. After interdisciplinary discussion, we decided to attempt clipping the aneurysm because interventional therapy did not seem feasible and anchoring a stent would also have been difficult because of the morphology of the aneurysm. The clipping attempt was unsuccessful because of the aneurysm’s massive calcification with strong adherence to the sphenoid planum. The aneurysm was then successfully occluded using pCONus 2-assisted coiling. We illustrate this and consecutive procedures, and we reviewed the literature on aneurysm calcification.
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Affiliation(s)
- Amer Haj
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Nils Ole Schmidt
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christina Wendl
- Department of Neuroradiology, University Medical Center Regensburg, Regensburg, Germany
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Yeomans J, Sastry A. pCONUS 2 and pCONUS 2-HPC for the treatment of wide-necked intracranial aneurysms: Periprocedural, 6-month, and early 2-year follow-up outcomes. Interv Neuroradiol 2021; 27:805-814. [PMID: 33887974 DOI: 10.1177/15910199211011887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/PURPOSE pCONUS 2 and pCONUS 2-HPC are novel neck-bridging devices designed to support endovascular coil occlusion of wide-necked intracranial bifurcation aneurysms. This study summarises periprocedural outcomes, 6-month, and early 2-year follow-up results following its introduction in an interventional neuroradiology centre. MATERIALS/METHODS This prospective, single-arm study assessed 20 aneurysms treated over a 40 month time period from time of procedure to 2 years post-procedure. Data collected included patient demographics, aneurysm features, and intraprocedural, 6-month, and 2-year post-procedural complications and angiographic features. RESULTS The mean age of the cohort was 59+-SD 7.7 years. 16 unruptured aneurysms were treated (pCONUS 2 13/16, pCONUS 2-HPC 3/16) and 4 ruptured aneurysms were treated with pCONUS 2-HPC. Unruptured cases received dual antiplatelet therapy pre- and post-procedure while ruptured cases received single antiplatelet therapy. 9/20 aneurysms were located at the MCA bifurcation and 7/20 at the basilar tip. The remaining 4 aneurysms were at various bifurcations in the anterior circulation. 11/20 were small (<10mm) and 9/20 were large (10-25mm). There was one periprocedural complication: a retroperitoneal bleed. There were no post-procedural intracranial complications or at 6-months follow-up. At 6 months, satisfactory occlusion was achieved in 94% of cases (15/16). There was one delayed death at 2-year follow-up from an unrelated cause. CONCLUSION pCONUS 2 and pCONUS 2-HPC have excellent short and medium-term safety profiles and clinical outcomes with no procedure-related mortality or morbidity and good occlusion rates at 6-month follow-up. The use of pCONUS 2-HPC with single antiplatelet therapy is feasible and did not cause any complications.
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Affiliation(s)
- J Yeomans
- University Hospital of Wales, Cardiff, UK
| | - A Sastry
- University Hospital of Wales, Cardiff, UK
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11
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Krupa K, Brzegowy P, Kucybała I, Łasocha B, Urbanik A, Popiela TJ. Endovascular embolization of wide-necked bifurcation aneurysms with the use of pCONus device: A systematic review and meta-analysis. Clin Imaging 2020; 70:81-88. [PMID: 33130244 DOI: 10.1016/j.clinimag.2020.10.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/24/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The following study aimed to summarize the overall safety and efficacy of the pCONus device in the treatment of wide-necked bifurcation aneurysms. MATERIAL AND METHODS Major electronic medical databases were thoroughly searched to identify relevant studies. Data regarding the type of included studies, type of aneurysm and its location, treatment results measured in Raymond-Roy Occlusion Class (RROC) and its complications, as well as patients' neurological outcome at the discharge were extracted from the eligible studies and included in the meta-analysis. The subgroup analyses dependent on the aneurysm rupture status were also conducted. RESULTS A total of 8 studies (198 patients with 200 aneurysms) were included in this meta-analysis. The most common localization of the treated aneurysms was the middle cerebral artery with its pooled prevalence estimate (PPE) of 44.5%. Immediately after the procedure, RROC I (complete obliteration of the aneurysm) was observed in 46.8%, RROC II in 32.9%, while RROC III (residual aneurysm) in 20.3% of the patients. In a short-term follow-up, PPE of RROC I was 55.0%, RROC II 29.0%, and RROC III 16.1%. The PPE of intraprocedural complications was 17.3%, the most frequent were thromboembolic events, which were observed in 12.1% of all procedures. Poor neurological outcome at the discharge was noted with PPE of 9.6%. CONCLUSIONS The effectiveness and safety of wide-necked bifurcation aneurysm treatment utilizing the pCONus device is moderate. There is still a need for a consensus regarding the effective antiplatelet regimen in furtherance of diminishing the rate of thromboembolic events.
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Affiliation(s)
- Kamil Krupa
- Department of Radiology, Jagiellonian University Medical College, 19 Kopernika Street, 31-501 Krakow, Poland; International Evidence-Based Anatomy Working Group (iEBA-WG), 12 Kopernika Street, 31-034 Krakow, Poland
| | - Paweł Brzegowy
- Department of Radiology, Jagiellonian University Medical College, 19 Kopernika Street, 31-501 Krakow, Poland
| | - Iwona Kucybała
- Department of Radiology, Jagiellonian University Medical College, 19 Kopernika Street, 31-501 Krakow, Poland.
| | - Bartłomiej Łasocha
- Department of Radiology, Jagiellonian University Medical College, 19 Kopernika Street, 31-501 Krakow, Poland
| | - Andrzej Urbanik
- Department of Radiology, Jagiellonian University Medical College, 19 Kopernika Street, 31-501 Krakow, Poland
| | - Tadeusz J Popiela
- Department of Radiology, Jagiellonian University Medical College, 19 Kopernika Street, 31-501 Krakow, Poland
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12
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Oushy S, Rinaldo L, Brinjikji W, Cloft H, Lanzino G. Recent advances in stent-assisted coiling of cerebral aneurysms. Expert Rev Med Devices 2020; 17:519-532. [PMID: 32500761 DOI: 10.1080/17434440.2020.1778463] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Stent-assisted coiling (SAC) of intracranial aneurysms paved the way for endovascular coiling of wide-neck and bifurcation aneurysms, improving rates of aneurysm obliteration and recurrence. In this review, we provide a comprehensive review of the most recent advances related to stent-assisted coiling of intracranial aneurysm. AREAS COVERED The authors have made an attempt to cover the inception, applications, and limitations of SAC of intracranial aneurysms. Special focus is given to 1) the current and recently introduced SAC techniques, 2) most recent advances in device technology, and 3) outcome data for the discussed techniques and devices. The authors also discuss the potential future direction of SAC. EXPERT OPINION technical refinements in the field of SAC should continue to focus on device development and addressing the limitations of SAC, namely aneurysm recurrence and need of antiplatelet agents. Although the recurrence rate of SAC has not been shown to be inferior to flow diverters, the use of intrasaccular and intravascular flow diverters are likely to expand in the future at the expense of SAC.
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Affiliation(s)
- Soliman Oushy
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA
| | - Lorenzo Rinaldo
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA.,Department of Radiology, Mayo Clinic , Rochester, MN, USA
| | - Harry Cloft
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA.,Department of Radiology, Mayo Clinic , Rochester, MN, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA.,Department of Radiology, Mayo Clinic , Rochester, MN, USA
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13
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Campos JK, Lien BV, Wang AS, Lin LM. Advances in endovascular aneurysm management: coiling and adjunctive devices. Stroke Vasc Neurol 2020; 5:14-21. [PMID: 32411403 PMCID: PMC7213502 DOI: 10.1136/svn-2019-000303] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/15/2020] [Accepted: 02/27/2020] [Indexed: 01/30/2023] Open
Abstract
Endovascular coil embolisation continues to evolve and remains a valid modality in managing ruptured and unruptured cerebral aneurysms. Technological advances in coil properties, adjunctive devices and interventional techniques continue to improve long-term aneurysm occlusion rates. This review elaborates on the latest advances in next-generation endovascular coils and adjunctive coiling techniques for treating cerebral aneurysms.
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Affiliation(s)
- Jessica K Campos
- Department of Neurological Surgery, University of California Irvine Medical Center, Orange, California, USA
| | - Brian V Lien
- Department of Neurological Surgery, University of California Irvine Medical Center, Orange, California, USA
| | - Alice S Wang
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California, USA
| | - Li-Mei Lin
- Carondelet Neurological Institute, St. Joseph's Hospital, Carondelet Health Network, Tucson, AZ, United States
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14
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Iosif C. Neurovascular devices for the treatment of intracranial aneurysms: emerging and future technologies. Expert Rev Med Devices 2020; 17:173-188. [PMID: 32141395 DOI: 10.1080/17434440.2020.1733409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Despite numerous advances in the endovascular treatment of intracranial aneurysms (IAs), treatment in cases of wide-neck, complex configurations or branching locations remains challenging. Apart from the paradigm shift introduced by flow diverters, several other devices have seen the light or are under development in order to address these challenges.Areas covered: We performed a review of the novel implantable endovascular devices which have been introduced for the treatment of IAs, from 1 January 2014 to 1 September 2019, excluding classic flow diverter and intracranial stent designs.Expert opinion: Alternative designs have been proposed for the treatment of IAs at branching positions, which do not jail the side branches, with or without flow diversion effect, most of which with good initial outcomes. Endosaccular devices have also been proposed, some of which with lower initial total occlusion rates. Alternative materials such as biopolymers have also been proposed and are under bench research. Despite the challenges in the exploitation of some of the new devices, most of them seem to provide solutions to some current technical shortcomings. The exploitation of the biological phenomena and the physical properties of the devices will allow us to expand the therapeutic armamentarium for more complex IA cases.
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Affiliation(s)
- Christina Iosif
- School of Medicine, European University of Cyprus, Nicosia, Cyprus.,Department of Interventional Neuroradiology, Henry Dunant Hospital, Athens, Greece.,Department of Interventional Neuroradiology, Iaso Hospital, Athens, Greece
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15
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Complex Wide-necked and Lobulated Aneurysm of the Middle Cerebral Artery Bifurcation : Treatment with a pCONUS2 Neck Bridging Device and p48MW Flow Modulation Device. Clin Neuroradiol 2019; 30:633-637. [PMID: 31807809 PMCID: PMC7471178 DOI: 10.1007/s00062-019-00862-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
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16
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Sirakov S, Panayotova A, Sirakov A, Penkov M, Minkin K, Hristov H. Using the pCANvas neck-bridging device in treating a wide-necked aneurysm of the basilar tip. Neuroradiol J 2019; 32:193-199. [PMID: 30942655 PMCID: PMC6512211 DOI: 10.1177/1971400919839375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND IMPORTANCE The endovascular treatment of recurrent wide-necked bifurcation aneurysms at the basilar tip remains very challenging. Many different techniques and devices have emerged in recent years as potential options but results remain less than controversial. The pCANvas is a relatively new device wielding neck-bridging properties with a haemodynamically active membrane acting as blood flow disrupter. CLINICAL PRESENTATION We present the clinical case of a patient in whom multiple endovascular and microsurgical attempts failed to achieve the definitive treatment of a large and wide-necked basilar tip aneurysm. The patient underwent successful endovascular implantation of the novel pCANvas device across the recurrent aneurysm neck. The device limited the blood flow to the anerysmal lumen and thus promoted faster thrombosis. Third month follow-up confirmed complete obliteration of the aneurysm. CONCLUSION The application of the pCANvas device offers a potential treatment option in difficult and recurrent aneurysms. The endovascular flow disruption is a relatively new feature aiming to create conditions for intraluminal thrombosis and is certainly promising for the treatment of complex bifurcation aneurysms.
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Affiliation(s)
| | | | | | - Marin Penkov
- Radiology Department, UH St Ivan Rilski,
Bulgaria
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17
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The pCONUS HPC: 30-Day and 180-Day In Vivo Biocompatibility Results. Cardiovasc Intervent Radiol 2019; 42:1008-1015. [PMID: 30868277 PMCID: PMC6542776 DOI: 10.1007/s00270-019-02202-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/07/2019] [Indexed: 12/20/2022]
Abstract
Background Endovascular stents are commonly used during neurointerventional procedures; however, the concomitant use of dual anti-platelet treatment (DAPT) can limit their use. There is a need to develop stent coatings that mitigate requirement for DAPT.
Methods The hydrophilic polymer coating is a novel glycan-based multilayer polymer that inhibits platelet adhesion. After Institutional Animal Care and Use Committee approval, 18 New Zealand white rabbits (mean weight 4.02 ± 0.51 kg) were commenced on DAPT (ASA 10 mg/kg/day and clopidogrel 10 mg/kg/day). A bare nitinol pCONUS and coated pCONUS HPC were implanted into the common carotid arteries of each rabbit. Histological examinations were performed at 30 days (n = 9) and 180 days (n = 8) to assess the acute and chronic inflammatory reactions to the pCONUS HPC. Wilcoxon/Kruskal–Wallis and ANOVA were used with p value < 0.05 considered as significant.
Results There is no statistically significant difference in inflammation within the intima/media or adventitia at 30 days (p = 0.3901 and p = 1, respectively) or at 180 days (p = 0.144 and p = 1, respectively) between pCONUS and pCONUS HPC cohorts. There is no significant difference in the presence of granulomas or giant cells between the cohorts at either 30 days (p = 1 and p = 0.8363) or 180 days (p = 1.00 and p = 0.149). At 30 days and 180 days, there was near-complete endothelialisation of the stent struts and no significant difference between the pCONUS or pCONUS HPC (p = 0.7832 and p = 0.334, respectively).
Conclusion pCONUS HPC stents do not elicit an acute or chronic inflammatory response in vivo with no significant difference in the tissue response to bare nitinol pCONUS stents or pCONUS HPC stents.
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18
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Sorenson TJ, Iacobucci M, Murad MH, Spelle L, Moret J, Lanzino G. The pCONUS bifurcation aneurysm implants for endovascular treatment of adults with intracranial aneurysms: A systematic review and meta-analysis. Surg Neurol Int 2019; 10:24. [PMID: 31123631 PMCID: PMC6416758 DOI: 10.4103/sni.sni_297_18] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/16/2018] [Indexed: 01/03/2023] Open
Abstract
Background The authors sought to assess the safety and early efficacy of the pCONUS Bifurcation Aneurysm Implants in a meaningful number of patients; we performed a systematic review and meta-analysis for the treatment of 203 intracranial aneurysms. Methods A literature search was performed by a reference librarian, and after screening nine case series were included in this analysis. We estimated from each study the cumulative incidence (event rate) and 95% confidence interval (CI) for each outcome. Event rates were pooled in a meta-analysis across studies using the random-effects model; descriptive statistics were reported when relevant. Results The pCONUS devices can be used with a technical success rate of 100% (95% CI: 0.98-1.00) and a technical complication rate of 0% (95% CI: 0.00-0.02). Perioperative morbidity and mortality rates were 7% (95% CI: 0.03-0.11) and 0% (95% CI: 0.00-0.01), respectively. Perioperative hemorrhage rate was 0% (95% CI: 0.00-0.02); rate of treatment-related long-term neurological deficit was 2% (95% CI: 0.00-0.06). The long-term complete occlusion rate was 60% (95% CI: 0.52-0.69) and retreatment rate was 14% (95% CI: 0.06-0.22). Conclusions The pCONUS devices are an additional tool for the treatment of wide-necked intracranial aneurysms with high rates of technical success and sufficiently low rates of morbidity and mortality. Comparative studies with longer-term follow-up are needed to clarify the role of this device in the management of challenging aneurysms.
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Affiliation(s)
- Thomas J Sorenson
- School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, USA
| | - Marta Iacobucci
- Department of Interventional Neuroradiology, NEURI Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Mohammad H Murad
- Center for Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | - Laurent Spelle
- Department of Interventional Neuroradiology, NEURI Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Jacques Moret
- Department of Interventional Neuroradiology, NEURI Center, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Clinic, Rochester, USA.,Department of Radiology, Mayo Clinic, Rochester, MN, USA
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19
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Varrassi M, Carducci S, Giordano AV, Masciocchi C. Re-treatment of an unruptured anterior communicating artery aneurysm using the new pCONus 2 device: Description of a case. Interv Neuroradiol 2018; 24:379-382. [PMID: 29781370 DOI: 10.1177/1591019918772156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Endovascular approach represents today the first option in treatment of ruptured and unruptured cerebral aneurysms. Nevertheless, wide-neck bifurcation aneurysms still represent a technical challenge for endovascular treatment due to the need to protect vessels arising next to the aneurysmal neck. A variety of devices have been implemented to ensure adequate assistance for coiling of these lesions. Among these devices, the new pCONus 2 represents an evolution of the well-known pCONus; compared to the previous one in fact, it allows a degree of articulation and flexibility between the shaft and the distal part (crown), making it more suitable for treatment of aneurysms presenting an angle between the longitudinal axis of the dome and parent vessel. We report our first case using pCONus 2 in the re-treatment of an unruptured anterior communicating artery aneurysm in a 57-year-old man, showing evident recanalization two years after coiling.
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Affiliation(s)
- Marco Varrassi
- 1 Radiology Department, San Salvatore Hospital, L'Aquila, Italy
| | - Sergio Carducci
- 1 Radiology Department, San Salvatore Hospital, L'Aquila, Italy
| | - Aldo V Giordano
- 1 Radiology Department, San Salvatore Hospital, L'Aquila, Italy
| | - Carlo Masciocchi
- 2 Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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20
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Lylyk P, Chudyk J, Bleise C, Henkes H, Bhogal P. Treatment of Wide-Necked Bifurcation Aneurysms : Initial Results with the pCANvas Neck Bridging Device. Clin Neuroradiol 2018; 29:467-477. [PMID: 29556668 PMCID: PMC6710216 DOI: 10.1007/s00062-018-0680-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 02/27/2018] [Indexed: 11/24/2022]
Abstract
Background Recently, numerous devices dedicated to the treatment of wide-necked aneurysms have become available. We present our initial experience with the pCANvas device and present the technical success rate, clinical outcome and immediate angiographic occlusion rates. Objective We sought to determine the efficacy of flow with the pCANvas for the treatment of unruptured intracranial aneurysms. Methods We performed a retrospective review of our prospectively collected data to identify patients treated with the pCANvas device between February 2015 and February 2017. The patient demographics, aneurysm characteristics, immediate and delayed clinical and radiographic follow-up data were recorded. Results We identified 17 patients (13 female) treated only with the pCANvas device. The average age of the patients was 60.5 ± 13.3 years (range 25–75 years). The average dome width was 7.6 ± 3.2 mm (range 3–15.8 mm), dome height 7.1 ± 3.2 mm (range 3–12.9 mm) and neck width 5.4 ± 3.2 (range 3–16.3 mm). The average aspect ratio was 1.5 ± 0.8 (range 0.6–3.7). At the end of the procedure 15 aneurysms continued complete filling of the aneurysm (Raymond Roy Classification[RRC] 3) with 2 aneurysms showing only filling of the neck of the aneurysm (RRC 2). Early follow-up angiography was available for 16 patients and at this stage 11 aneurysms showed persistent and complete filling of the aneurysm (RRC 3), 5 aneurysms showed complete occlusion of the aneurysm (RRC 1) and 7 aneurysms underwent repeat treatment with coiling. Conclusion The early results on the use of the pCANvas are promising; however, longer term follow-up and larger studies are required.
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Affiliation(s)
- P Lylyk
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - J Chudyk
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - C Bleise
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - H Henkes
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Kriegsbergstr 60, 70174, Stuttgart, Germany.,Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - P Bhogal
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Kriegsbergstr 60, 70174, Stuttgart, Germany.
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