Hybrid Y Stenting with the Waffle-Cone

Limbucci, Nicola; Nappini, Sergio; Renieri, Leonardo; Consoli, Arturo; Rosi, Andréa; Grillea, Giovanni; Bartolo, Marcello; Mangiafico, Salvatore

doi:10.15274/inr-2014-10065

Cited by 6 publications

(3 citation statements)

References 25 publications

(46 reference statements)

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“…6 7 The WCT consists of placing the intracranial stent in the parent vessel at the level of the neck of the aneurysm without entering the efferent branches of the bifurcation. This technique was described using self-expanding stents, [6][7][8][9][10][11][12] originally meant to be deployed in the parent vessel, bridging the aneurysm neck from outside the sac. None of these stents opened distally beyond the physical diameter of the shaft once deployed in the aneurysm.…”

Section: Introductionmentioning

confidence: 99%

Intra-aneurysmal hemodynamics: evaluation of pCONus and pCANvas bifurcation aneurysm devices using DSA optical flow imaging

Pérez

Henkes

Bouillot

et al. 2015

J NeuroIntervent Surg

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BackgroundImplantation of self-expanding stents from the parent artery into the sac of a bifurcation aneurysm is regularly used to facilitate endovascular coil occlusion with the so-called waffle cone technique (WCT). Self-expanding aneurysm bridging stents like Solitaire AB, can be used; however, bifurcation devices like pCONus and pCANvas are especially designed for WCT. These devices provide additional support for coil implantation owing to intraluminal nylon fibers (pCONus) or membranes (pCANvas) covering the intracranial aneurysm neck.ObjectiveAssessment of the intra-aneurysmal hemodynamic impact of these three devices: a regular intracranial stent (Solitaire AB) and two bifurcation devices (pCONus and pCANvas).Material and methodsAn in vitro experiment was set up using a silicone model of a basilar tip aneurysm filled with blood mimicking fluid under a pulsatile circulation. Solitaire AB, pCONus, and pCANvas were successively implanted in the model for hemodynamic evaluation. High frame rate DSA series were acquired under various conditions. Intra-aneurysmal flow changes, including mean aneurysm flow amplitude ratio (R), were subsequently assessed by the optical flow method, measuring the detector velocity field before and after device implantations.ResultspCONus and Solitaire minimally reduced the intra-aneurysmal flow (R=0.96, p=0.17 and R=0.91, p=0.01, respectively), whereas pCANvas strongly diminished the intra-aneurysmal flow (R=0.41, p=5×10−12).ConclusionsWaffle cone deployment of stents and technique-specific devices had no undesirable effect on the intra-aneurysmal flow. In particular, no increased flow was redirected into the aneurysm sac. The intraluminal membrane of the pCANvas strongly reduced the intra-aneurysmal flow, potentially preventing recanalization problems.

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Section: Introductionmentioning

confidence: 99%

Intra-aneurysmal hemodynamics: evaluation of pCONus and pCANvas bifurcation aneurysm devices using DSA optical flow imaging

Pérez

Henkes

Bouillot

et al. 2015

J NeuroIntervent Surg

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“…The name derives from the fact that it looks like an ice cream cone and its design is a further evolution of the “waffle-cone technique,” which has been used in the past for stent-assisted coiling of challenging aneurysms. [ 6 8 15 ] There are now several devices in the market that address a similar niche.…”

Section: Discussionmentioning

confidence: 99%

The pCONUS bifurcation aneurysm implants for endovascular treatment of adults with intracranial aneurysms: A systematic review and meta-analysis

et al. 2019

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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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“…4). Limbucci et al [10] similarly combined the waffle-cone technique with Y stent-assisted coiling for endovascular treatment of wide-necked bifurcation aneurysm. They used the Solitaire ® stent successfully in 3 of 4 cases.…”

Section: Discussionmentioning

confidence: 99%

Modified Y-configured stents with the waffle-cone technique by use of Solitaire® stent for patients with wide-necked bifurcation aneurysms

et al. 2015

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Endovascular treatment of wide-necked bifurcation aneurysms can be challenging, despite improvements in endovascular techniques. Y stent-assisted coiling is one such technique, but this may not be technically feasible, especially in cases of acute angulation between the proximal and distal parent arteries, and may require use of "modified Y-configured stents with the waffle-cone technique". We report three cases of wide-necked bifurcation aneurysms that were successfully treated by use of the Solitaire® stent.

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Hybrid Y Stenting with the Waffle-Cone

Cited by 6 publications

References 25 publications

Intra-aneurysmal hemodynamics: evaluation of pCONus and pCANvas bifurcation aneurysm devices using DSA optical flow imaging

Intra-aneurysmal hemodynamics: evaluation of pCONus and pCANvas bifurcation aneurysm devices using DSA optical flow imaging

The pCONUS bifurcation aneurysm implants for endovascular treatment of adults with intracranial aneurysms: A systematic review and meta-analysis

Modified Y-configured stents with the waffle-cone technique by use of Solitaire® stent for patients with wide-necked bifurcation aneurysms

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