The pCONUS2 and pCONUS2 HPC Neck Bridging Devices

Abstract

Introduction Bifurcation aneurysms represent an ongoing endovascular challenge with a variety of techniques and devices designed to address them. We present our multicenter series of the pCONUS2 and pCONUS2 HPC devices when treating bifurcation aneurysms. Methods We performed a retrospective review of our prospectively maintained databases at 3 tertiary neurointerventional centers to identify all patients who underwent coil embolization with the pCONUS2 or pCONUS2 HPC device between February 2015 and August 2021. We recorded baseline demographics, aneurysm data, complications, immediate and delayed angiographic results. Results We identified 55 patients with 56 aneurysms, median age 63 years (range 42–78 years), 67.3% female (n = 37). The commonest aneurysm location was the MCA bifurcation (n = 40, 71.4%). Average dome height was 8.9 ± 4.2 mm (range 3.2–21.5 mm), average neck width 6.4 ± 2.5 mm (range 2.6–14 mm), and average aspect ratio 1.3 ± 0.6 (range 0.5–3.3). The pCONUS2 was used in 64.3% and the pCONUS2 HPC in 35.7%. The procedural technical success rate was 98.2%. Intraoperative complications occurred in 5 cases (8.9%), 4 of which were related to the coils with partial thrombus formation on the pCONUS2 HPC seen in 1 case that was resolved with heparin. In relation to the procedure and treatment of the aneurysm the overall permanent morbidity was 1.8% (n = 1/55) and mortality 0%. Delayed angiographic follow-up (48 aneurysms) at median 12 months postprocedure (range 3–36 months) demonstrated adequate occlusion of 83.4% of aneurysms. Conclusion The pCONUS2 and pCONUS2 HPC devices carry a high technical success rate, low complication and retreatment rate, and good rates of adequate occlusion. Larger prospective confirmatory studies are required.

Endovascular treatment of wide-necked intracranial aneurysms using the Nautilus Intrasaccular System: initial case series of 41 patients at a single center

“…The ANSWER trial assessed 34 patients with a WNBA treated with PulseRider, demonstrating RR I or II occlusion in 87.9% of patients at 6 months, with mRS 0–2 in 94% of patients. 28 A 2022 multicenter study 29 that used the pCONUS2 device in 55 patients with mostly bifurcation aneurysms found a technical success rate of 98.2%, a complication rate of 8.9%, a permanent morbidity rate of 1.8%, mortality rate of 0%, and occlusion rate of 83.4%. A 2019 study 30 using the pCANVAS device in 17 patients with unruptured aneurysms observed an RR class 3 in 68.8% of patients (11/16) and RR class 1 in 31.2% of patients (5/16) at follow-up.…”

Endovascular treatment of wide-neck bifurcation aneurysms using pCONUS2 HPC bridging device with single antiplatelet: A Case Series

“…Literature review with breakdown on the characteristics of the WNBA, immediate and delayed angiographic outcomes, retreatment rates, peri-and post procedural complications and details on the post procedural antiplatelet regimen for each case series were included. [2,[6][7][8] No The US WEB-IT study recently concluded a 5-year prospective evaluation of the efficacy of the Woven EndoBridge (WEB) aneurysm embolization system (Sequent Medical Inc). It demonstrated a last observation carried forward (LOCF) complete occlusion rate of 58.1%, and a satisfactory occlusion rate of 87.2%.…”

Endovascular Treatment of Wide-Neck Bifurcation Aneurysm: Recent Trends in Coil Embolization with Adjunctive Technique

“…There have been several reports on pCONUS2 and pCONUS2 HPC. 45 , 46) The unruptured cases received dual antiplatelet therapy, while ruptured cases received single antiplatelet therapy. The rate of complete occlusion at follow-up was 62.5%–68.8%, and intraprocedural thrombus formation occurred in 1.8% of patients.…”