Endovascular embolization of wide-necked bifurcation aneurysms with the use of pCONus device: A systematic review and meta-analysis

Krupa, Kamil; Brzegowy, Paweł; Kucybała, Iwona; Łasocha, Bartłomiej; Urbanik, Andrzej; Popiela, T

doi:10.1016/j.clinimag.2020.10.025

Cited by 14 publications

(14 citation statements)

References 39 publications

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“…Meanwhile, several retrospective studies on pCONUS became available, but these studies were limited to small cohorts [10][11][12][13][14][15][16]. Recently, Krupa et al [17] summarized the pCONUS literature in a systematic review and meta-analysis, with a total of eight studies (198 patients with 200 aneurysms) included. Immediately after the procedure, adequate occlusion was observed in 79.7% of patients, increasing further to 84.0% at the six-month mark.…”

Section: Discussionmentioning

confidence: 99%

Results of the pToWin Study: Using the pCONUS Device for the Treatment of Wide-Neck Intracranial Aneurysms

Aguilar-Pérez

Henkes

Kurre

et al. 2022

JCM

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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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Section: Discussionmentioning

confidence: 99%

Results of the pToWin Study: Using the pCONUS Device for the Treatment of Wide-Neck Intracranial Aneurysms

Aguilar-Pérez

Henkes

Kurre

et al. 2022

JCM

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“…pCONus is a device with four petals and is implanted inside the aneurysm at its neck, whereas the shaft is anchored in the parent vessel. Krupa et al performed a meta-analysis ( 35 ). They found eight one-arm studies for analysis, and the effectiveness and safety of the device were considered to be “moderate.” More recently, the results of the pToWin study, a prospective, single-arm, multicenter study conducted to analyze the safety and efficacy of the pCONus, have been published ( 36 ).…”

Section: Discussionmentioning

confidence: 99%

Section: Neck Supporting Devicesmentioning

confidence: 99%

Treatment of unruptured middle cerebral artery aneurysms: Systematic review in an attempt to perform a network meta-analysis

Arrese

García-García²,

Cepeda³

et al. 2022

Front. Surg.

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ObjectiveOpen surgical clipping has been generally considered the best treatment option for unruptured middle cerebral artery aneurysms (uMCAAs). However, this type of aneurysm is being treated endovascularly with the appearance of new devices. We have carried out a systematic review of randomized and quasi-experimental studies to conduct a network meta-analysis (NMA) to assess the safety and efficacy of the different treatment methods currently used in uMCAAs.MethodsThe literature was searched by using PubMed and Google Scholar databases. Eligibility criteria were randomized or quasi-experimental studies including at least five cases per arm and reporting duration of follow-up and number of lost cases. The end points were: angiographic success, final neurological outcome, and the need for retreatments.ResultsWe could only analyze four quasi-experimental studies with 398 uMCAAs. All of them compared clipping vs. coiling. Clipping showed better results than coiling in all analyzed end points. We could not conduct the proposed NMA because of the absence of randomized or quasi-experimental studies. Instead, a systematic review is further discussed.ConclusionsThere is an urgent need for comparative studies on the treatment of uMCAAs.

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“…The pCONus is a laser-cut, electrolytically-detachable, resheathable, self-expanding stent-like device with a distal crown and four petals that deploy within the aneurysm and bridge the aneurysm neck. A meta -analysis of 200 wide-necked bifurcation aneurysms treated with pCONus was notable for a thromboembolic complication rate of 12.1% [ 19 ]. pCONus has been used in a small series of 21 patients with acutely ruptured aneurysms, along with dual antiplatelet therapy, resulting in a 62% rate of modified Raymond-Roy classification 1–2 at immediate angiography [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Intrasaccular flow disruption (WEB) of a large wide-necked basilar apex aneurysm using PulseRider-assistance

Narsinh¹,

Caton²,

Mahmood

et al. 2021

Interdisciplinary Neurosurgery

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Large, wide-necked basilar apex aneurysms are difficult to treat. Microsurgical clipping can result in neurologic morbidity and mortality. Endovascular treatment often leaves remnants that need retreatment and/or stent placement with dual antiplatelet therapy. The Woven EndoBridge (WEB) is an intrasaccular flow disruption device that can be used without dual antiplatelet therapy. However, the WEB cannot typically be used in large or giant aneurysms > 10 mm because the largest diameter device is the 11 × 9.6 mm single layer sphere (SLS). We present a case in which we use a PulseRider aneurysm neck reconstruction device in the basilar artery to assist in WEB deployment within a 22 mm basilar apex aneurysm with 14 mm neck, thereby permitting aspirin monotherapy postoperatively.

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Endovascular embolization of wide-necked bifurcation aneurysms with the use of pCONus device: A systematic review and meta-analysis

Cited by 14 publications

References 39 publications

Results of the pToWin Study: Using the pCONUS Device for the Treatment of Wide-Neck Intracranial Aneurysms

Results of the pToWin Study: Using the pCONUS Device for the Treatment of Wide-Neck Intracranial Aneurysms

Treatment of unruptured middle cerebral artery aneurysms: Systematic review in an attempt to perform a network meta-analysis

Intrasaccular flow disruption (WEB) of a large wide-necked basilar apex aneurysm using PulseRider-assistance

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