Use of the pCONus HPC as an adjunct to coil occlusion of acutely ruptured aneurysms: early clinical experience using single antiplatelet therapy

Abstract

BackgroundCoil occlusion has become the standard treatment for many ruptured aneurysms. However, specific aneurysm structures pose technical difficulties and may require the use of adjunctive neck-bridging devices, which necessitate the use of dual antiplatelet therapy. The hydrophilic polymer coating (pHPC, phenox) is a surface modification that inhibits platelet adhesion.ObjectiveTo present initial experience with the pCONUS HPC device as an adjunct to coil embolization for ruptured aneurysms using single antiplatelet therapy (SAPT).MethodsAll patients who were treated with the pCONUS HPC for ruptured aneurysms using SAPT were retrospectively identified. The occurrence of thromboembolic and hemorrhagic complications was recorded together with the angiographic and clinical follow-up details.ResultsFifteen patients were identified (nine female) with a median age of 54 years (range 27–81). Six aneurysms were located at the anterior communicating artery, five at the middle cerebral artery bifurcation, two at the basilar artery bifurcation, one at the posterior communicating artery, and one involving the intradural internal carotid artery. Ten patients (66.6%) achieved modified Raymond–Roy classification I or II at post-treatment angiography, with 45.5% of patients having adequate occlusion (defined as complete occlusion or neck remnant) at follow-up. All patients received acetylsalicylic acid (ASA) as SAPT before and after the procedure. Intraprocedural thrombus formation was seen in three patients (20%), resolving in two patients after a bolus dose of eptifibatide, and one treated with mechanical aspiration. No clinical or radiological consequences were seen. There were no recurrent aneurysm ruptures. One patient died owing to cerebral vasospasm.ConclusionThis initial clinical experience highlights the possibility and limitations of using the pCONUS HPC device in the treatment of complex ruptured aneurysm with ASA as SAPT. Randomized trials with longer follow-up in larger cohorts are underway.

Neurointervention in the 2020s: Where are We Going?

“…There is however an ongoing race among manufacturers to develop antithrombogenic coatings for stents and flow diverters to obviate the need for dual antiplatelet regimens. First case series have already been published and show encouraging results [ 27 , 28 ]. Remote mentoring is another highly desirable development that will probably soon find its way into clinical routine, partly because one-on-one/in person teaching has become very challenging, if not impossible, during the COVID-19 pandemic.…”

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

“…They reported three instances of intraprocedural thrombus formation and no hemorrhagic complications. 8 In this series, all but two patients required increased doses of ASA to maintain adequate platelet inhibition. This preliminary data suggests that pHPC may play a role in the treatment of selected aneurysms which are not suitable for other interventions, but that adequate management of the SAPT prior to and after treatment must be meticulous.…”

“…A detailed description of the pCONUS1 and pCONUS2 as well as its coated versions has previously been given by other authors. 8 …”

Efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm—A systematic review and meta-analysis

“…26 A study on pCONUS HPC device in an acutely ruptured aneurysm showed 66.6% initial RR1 + RR2 and 45.5% at a median of five-month follow-up. 27 Patients in the study received aspirin before and after the procedure which was then followed by a lifetime 100 mg aspirin. 27 There was intraprocedural thrombus formation requiring further treatment in 20% of the patients; 27 however, there was no periprocedural or postprocedural aneurysm re-rupture.…”

“…27 Patients in the study received aspirin before and after the procedure which was then followed by a lifetime 100 mg aspirin. 27 There was intraprocedural thrombus formation requiring further treatment in 20% of the patients; 27 however, there was no periprocedural or postprocedural aneurysm re-rupture. A study on eClips devices demonstrated 81% modified RR1 + RR2 at an average of eight-month follow-up along with 12% periprocedural complications (2 transient ischemic attacks and 2 asymptomatic thrombotic events).…”