PulseRider Stent-Assisted Coiling of Wide-Neck Bifurcation Aneurysms: Periprocedural Results in an International Series

Abstract

SUMMARY:The PulseRider is a novel endovascular device specifically designed to treat bifurcation intracranial aneurysms with wide necks. In an international series, we report the results of PulseRider stent-assisted coiling of 15 patients (9 women and 6 men; mean age, 62.6 years) with 15 unruptured wide-neck (median dome size, 8 mm; median neck size, 5 mm) bifurcation aneurysms. Failure of PulseRider treatment occurred in 1 case, and 1 intraprocedural thromboembolic complication was observed. There was no mortality or neurologic permanent morbidity at discharge and at 1 month. Immediate angiographic outcome showed 12 complete occlusions and 2 neck remnants. Follow-up at 6 months was available for 3 aneurysms and demonstrated 2 complete aneurysm occlusions and 1 growing neck remnant. In this small series of selected patients, PulseRider stent-assisted coiling of wide-neck bifurcation aneurysms was feasible with low procedural complication rates. Angiographic follow-up will be required to evaluate the efficacy of the PulseRider device. ABBREVIATION: IA ϭ intracranial aneurysm

pCONus Device for the Endovascular Treatment of Wide-Neck Middle Cerebral Artery Aneurysms

“…A novel assisted coiling device, the PulseRider aneurysm neck reconstruction device (Pulsar Vascular, San Jose, California), intended for use in the treatment of wide-neck aneurysms arising at bifurcations, was used in 3 patients; however, the article is in press and no follow-up is available with this new device. 25,26 In the present series, immediate adequate aneurysm occlusion (complete occlusion or neck remnant) was achieved in most cases (72.5%). Moreover, no case of angiographic in-stent stenosis or jailed branch occlusion was observed.…”

LVIS Jr ‘shelf’ technique: an alternative to Y stent-assisted aneurysm coiling

“…Treatment of 15 wide-necked bifurcation intracranial aneurysms with the unique arch design PulseRider stent (Pulsar Vascular, San Jose, California, USA) showed low procedural complication rates. Imaging follow-up was only available for three patients, but showed similar occlusion rates to ours 15. Results are varied for the WEB-DL braided wire intrasaccular flow diverter (Sequent Medical, Aliso Viejo, California, USA).…”

Republished: Flanking the fenestration: circumferential limb-to-limb stent-assisted coiling of a basilar artery fenestration aneurysm

“…To address concerns of inadequate coverage and thrombogenic burden, new devices such as the woven endobridge (WEB) (Sequent Medical, Aliso Viejo, California, USA), PulseRider (Pulsar Vascular, San Jose, California, USA) and pCONus (Phenox, Bochum, Germany) have been designed for complex junctional aneurysms with promising results 6. However, patient selection is important as these devices can require rigid deployment systems and wide-necked aneurysms with a low dome-to-neck ratio may not be able to support device positioning 15. Our current case highlights the benefit of new low-profile, compliant stents like the LVIS Jr (MicroVention, Aliso Viejo, California, USA) for novel approaches to complex and wide-necked aneurysms.…”