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

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.

Use of pCONUS HPC for the treatment of unruptured wide-necked bifurcation aneurysms: early clinical experience using single antiplatelet therapy

“…However, our data do not allow us to conclude that a staged approach is superior as there was a higher rate of thromboembolic complications in our series than in others where the treatment was performed in a single session. 1 8 Additionally, only 10 of our 15 patients were available for follow-up and this follow-up period was too short to provide any insight into whether residual or recurrent aneurysm formation can occur. Nevertheless, recurrent aneurysm perfusion prompting retreatment has been observed after coiling 36 and has not been overcome with newer implants like the Woven EndoBridge (WEB; MicroVention, Aliso Viejo, California, USA).…”

“…Unlike the standard technique for the use of the pCONUS, in which device implantation and coil occlusion are performed in one setting, all patients included in this series underwent a stepwise treatment, in which the pCONUS was implanted in the first intervention, followed by coiling of the aneurysm in a subsequent session. Though the one setting technique has been shown to be technically successful and safe, complete occlusion rates at follow‐up was only 60% in the meta-analysis by Sorensen et al , 1 with 14% of aneurysms requiring retreatment. Our logic behind performing staged treatment was to enable some endothelialisation of the pCONUS between sessions.…”

“…Wide-necked bifurcation aneurysms (WNBA) have classically been considered challenging for endovascular treatment (EVT). In recent years, numerous stent-like devices have specifically been designed to treat this kind of aneurysms, including the pCONUS 1 and the pCANVAS 2 (phenox, Bochum, Germany), the PulseRider 3 (Pulsar Vascular, Los Gatos, California, USA) and the eCLIPs 4 (Evasc Medical Systems Corp). Although these devices have facilitated the treatment of WBNA, the need for dual antiplatelet therapy (DAPT) to prevent thromboembolic complications remains a major issue.…”

Anterior Communicating Artery Aneurysm: Ruptured Wide-Necked Anterior Communicating Artery Aneurysm Incorporating Both A2 Anterior Cerebral Arteries; Staged Treatment with “Protective” Partial Coiling in the Acute Phase; and Definitive Treatment 2 Years Later with pCONUS1-Assisted Coiling, Achieving Complete and Permanent Aneurysm Occlusion

“…A recent systematic review and meta-analysis (Sorenson et al 2019) evaluated nine case series reporting on the use of pCONUS in the treatment of 203 bifurcation aneurysms. The device was used primarily for the treatment of middle cerebral artery (45%), AcomA (34%), and basilar apex (15%) aneurysms.…”

Endovascular treatment of basilar tip aneurysms in the era of endosaccular flow disruption: a comparative study

“…A variety of different techniques has been developed to enable safe and successful endovascular treatment of bifurcation aneurysms including balloon and stent assistance in various configurations and recently developed neck-bridging devices [ 1 , 2 ]. However, all these techniques require several steps, making the procedure complex and prone to device- and procedure-related complications.…”