Original ArticleThe pCONus Device for Treatment of Complex Wide-Neck Anterior Communicating Artery Aneurysms
Introduction
The anterior communicating artery (AcomA) is one of the most frequent locations of intracranial aneurysms,1, 2, 3 and endovascular coiling of these aneurysms could not be feasible in the setting of large and/or wide neck.4, 5 Balloon remodeling and stent-assisted coiling allow the endovascular treatment of wide-neck AcomA aneurysms,6, 7, 8 but seems associated with a higher procedure-related morbidity and mortality, especially in cases of double intracranial stenting.8 At present, there is a need of a safe endovascular approach in these aneurysms with unfavorable anatomy. A new device, the pCONus (phenox GmbH, Bochum, Germany) has recently been developed to improve the safety of treatment of intracranial bifurcation aneurysms with a wide neck.6, 9, 10 To our knowledge no study assesses the safety and efficacy of pCONus for AcomA aneurysms.
We reported the immediate and 1-year clinical and anatomic post-treatment results of consecutive patients harboring wide-neck AcomA aneurysms treated with the pCONus device.10
Section snippets
Patients
We retrospectively analyzed the results of consecutive patients who had the pCONus stent-assisted coiling for AcomA aneurysms between June 2012 and December 2015 in 3 European centers (Lyon and Besançon, France; Stuttgart, Germany). The inclusion was done in the acute ruptured phase, or the recanalized or unruptured status. Decision of the pCONus stent-assisted coiling strategy was made at the discretion of the operator. All patients were informed of the procedure, respective to the
Results
During the study period, 36 patients harboring 36 saccular AcomA aneurysms were treated with pCONus. They were 16 women and 20 men ranging in age from 34–83 years (mean, 61 years). Seven (19%) patients were treated at the acute phase of rupture, 24 (67%) patients harbored unruptured aneurysm, and 5 (14%) were recanalyzed aneurysm (all of these 5 aneurysms were previously treated with an endovascular approach).
Baseline aneurysm characteristics were dome sizes ranged from 3–15.1 mm (mean, 7.3 mm)
Clinical Results
Our preliminary series of 36 patients showed that pCONus stent-assisted coiling of AcomA aneurysms with complex anatomy and/or wide-neck was feasible. Postoperative neurological deficit was observed in 5 patients; however, only 3 permanent neurological complications were observed and no patient died from complication directly related to the procedure. Thus, pCONus intracranial stenting presented no mortality and the permanent morbidity rate at 90 days was 11%. Recently published studies6, 10
Conclusions
However, our preliminary evaluation of this new endovascular approach for the treatment of AcomA aneurysms with unfavorable anatomy shows that the pCONus device can be a feasible option for such complex lesions.
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Cited by (19)
Endovascular embolization of wide-necked bifurcation aneurysms with the use of pCONus device: A systematic review and meta-analysis
2021, Clinical ImagingCitation Excerpt :A summary of these results is shown in Table 2. Six studies were included into subgroup analysis of immediate treatment results: 4 studies with both ruptured (n = 19) and unruptured aneurysms (n = 77) [5,7,12,14], one study only with ruptured aneurysms (n = 21) [8] and one study with only unruptured aneurysms (n = 19) [13]. The subgroup analysis showed that complete occlusion (RROC I) rate immediately after the procedure was less frequently observed in ruptured aneurysms which was seen in 46.8% (95% CI: 32.8–63.1) of cases when compared to unruptured aneurysms, seen in 54.3% (95% CI: 29.9–74.4) (Table 2) of cases, but the difference was not statistically significant (p = 0.478).
The pCONus2 Neck-Bridging Device: Early Clinical Experience and Immediate Angiographic Results
2018, World NeurosurgeryCitation Excerpt :At the distal end of the stent structure are 6 polyamide fibers that form a cross and provide extra support to the coil ball mass. Several studies have addressed the use of the pCONus1.11-20 The second-generation pCONus2 device features further design improvements aimed at improving functionality and ease of use.
Anterior communicating artery aneurysms
2018, Intracranial AneurysmsCurrent concepts regarding the endovascular management of unruptured wide-necked bifurcation cerebral aneurysms
2023, Rentgenologiya i RadiologiyaNeuroendovascular Management of Wide-Neck Bifurcation Aneurysms
2022, Endovascular Surgery of Cerebral Aneurysms
Paul Emile Labeyrie, Benjamin Gory, Elisa Pomero, Alessandra Biondi, Roberto Riva, Francis Turjman do not have any conflict of interest; Marta Aguilar-Perez is a consultant for phenox GmbH; and Hans Henkes is a co-founder and shareholder of phenox GmbH.