Long-term follow-up of the pCONus device for the treatment of wide-neck bifurcation aneurysms

Abstract

Purpose Wide-neck bifurcation aneurysms remain challenging for the neurointerventionist and/or neurosurgeon despite many recent advances. The pCONus (Phenox, Bochum, Germany) is an emerging device for endovascular neck protection, we report the first long-term results of this device. Methods We performed a retrospective analysis of all consecutive intracranial wide-neck bifurcation aneurysms treated with the pCONus. Patients' characteristics were reviewed, procedural complications, angiographic (Roy-Raymond scale) and clinical outcomes were documented. Results Between January 2016 and September 2019, 43 patients (74% female, median age 56 [49–66] years) with 43 wide-neck bifurcation aneurysms (mean width of 6.8 ± 2.1 mm, dome/neck ratio of 1.3 ± 0.2 and neck of 5.2 ± 1.3 mm) were included. A procedural angiographic complication was reported in five patients (12%), no patient presented a post-operative neurological deficit or long-term complication, mortality rate was 0%. At last follow-up (median of 46.5 months [38.3–51.7]), an adequate occlusion (complete and neck remnant) was observed in 37/43 patients (86%) and an aneurysm remnant in 6/43 (14%). Four patients (9%) needed retreatment. No in-stent stenosis or branch occlusion was depicted. Conclusion pCONus device provides a safe and efficient alternative for endovascular wide-neck bifurcation aneurysms management, with long-term stability.

Stenting-assisted embolization of a saccular aneurysm of the azygos anterior cerebral artery associated with fenestration at its beginning

“…2 In this era of evolving endovascular technology and techniques, there are an increasing number of choices to treat saccular AACA aneurysms, including single coiling with double microcatheters, stenting or balloon-assisted coiling, and the waffle-cone technique to assist coiling. 20,22,23 Even with the assistance of the double microcatheter technique, single coiling is not always safe for AACA wide-necked aneurysms, and coil migration can occur. 20 For balloonassisted coiling of AACA aneurysms, traditional balloon catheters were still stiff and thick for access to the distal ACA.…”

Endovascular treatment of middle cerebral artery aneurysms: current status and future prospects

“…Compared with other devices, pCONus devices were popularly used, including pCONus 1, pCONus 2, pCONus 2 HPC, and pCANvas devices. The pCONus devices are stent-like self-expanding nitinol implants that blossom like a flower inside the aneurysm to facilitate the "waffle-cone technique" (88)(89)(90)(91)(92). Some reports have shown that the use of a pCONus device to assist in coiling of MCA aneurysms successfully treats more than 95% of cases and achieves adequate aneurysm occlusion in more than 80% of cases, such as in Ulfert et al 's report (93), in the pToWin trial (94), in Morales-Caba et al 's report (91), and in Yeomans et al 's report (92).…”