Skip to main content
SpringerLink
Log in

The pCONus Device in Treatment of Wide-necked Aneurysms

Technical and Midterm Clinical and Angiographic Results

  • Original Article
  • Published:
Clinical Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

A variety of devices for treatment of wide-necked bifurcation aneurysms are emerging. Here we report our results using the new pCONus device with special emphasis on the morphological and anatomical requirements for successful implantation.

Methods

In this study we treated 21 patients with 22 aneurysms by endovascular interventions. After providing informed consent, patients were included according to the following criteria: aneurysm dome to neck ratio <2 or neck diameter >4 mm. The primary end points for clinical safety were the absence of death, absence of major or minor stroke and absence of transient ischemic attack.

Results

A total of 22 aneurysms in 21 patients were treated with pCONus-assisted coiling. In 19 patients harboring 20 aneurysms the implantation of the device was successful and these aneurysms showed an adequate occlusion after 6 months in 95 %. The complication rate was low (5 %) with one case of minor neurological stroke. Analysis of the data showed that the difference in aneurysm angulation between successful (mean 45°) and failed implantations (mean 71.5°) was highly significant.

Conclusion

Use of the pCONus device and coiling in wide-necked bifurcation aneurysms is safe and provides good occlusion rates but might be limited by the angulation between the aneurysm and the parent vessel.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Brinjikji W, Cloft HJ, Kallmes DF. Difficult aneurysms for endovascular treatment: overwide or undertall? AJNR Am J Neuroradiol. 2009;30(8):1513–7.

  2. Debrun GM, Aletich VA, Kehrli P, Misra M, Ausman JI, Charbel F, Shownkeen H. Aneurysm geometry: an important criterion in selecting patients for Guglielmi detachable coiling. Neurol Med Chir (Tokyo). 1998;38(Suppl):1–20.

  3. Fernandez Zubillaga A, Guglielmi G, Viñuela F, Duckwiler GR. Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR Am J Neuroradiol. 1994;15(5):815–20.

  4. Moret J, Cognard C, Weill A, Castaings L, Rey A. The “Remodelling Technique” in the treatment of wide neck Intracranial aneurysms. Angiographic results and clinical follow-up in 56 cases. Interv Neuroradiol. 1997;3(1):21–35.

    Article  CAS  PubMed  Google Scholar 

  5. Bartolini B, Blanc R, Pistocchi S, Redjem H, Piotin M. “Y” and “X” stent-assisted coiling of complex and wide-neck intracranial bifurcation aneurysms. AJNR Am J Neuroradiol. 2014;35(11):2153–8.

  6. Fischer S, Vajda Z, Aguilar Perez M, Schmid E, Hopf N, Bäzner H, Henkes H. Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections. Neuroradiology. 2012;54(4):369–82.

  7. Lubicz B, Mine B, Collignon L, Brisbois D, Duckwiler G, Strother C. WEB device for endovascular treatment of wide-neck bifurcation aneurysms. AJNR Am J Neuroradiol. 2013;34(6):1209–14.

  8. Sychra V, Klisch J, Werner M, Dettenborn C, Petrovitch A, Strasilla C, Gerlach R, Rosahl S, Holtmannspötter M. Waffle-cone technique with Solitaire™ AB remodeling device: endovascular treatment of highly selected complex cerebral aneurysms. Neuroradiology. 2011;53(12):961–72.

  9. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, Lamoureux J, Chagnon M, Roy D. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke. 2003;34(6):1398–403.

  10. Wilson JT, Hareendran A, Grant M, Baird T, Schulz UG, Muir KW, Bone I. Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin Scale. Stroke. 2002;33(9):2243–6.

  11. Kovács A, Möhlenbruch M, Hadizadeh DR, Seifert M, Greschus S, Clusmann H, Willinek WA, Flacke S, Urbach H. Noninvasive imaging after stent-assisted coiling of intracranial aneurysms: comparison of 3‑T magnetic resonance imaging and 64-row multidetector computed tomography – a pilot study. J Comput Assist Tomogr. 2011;35(5):573–82.

  12. Majoie CB, Sprengers ME, van Rooij WJ, Lavini C, Sluzewski M, van Rijn JC, den Heeten GJ. MR angiography at 3 T versus digital subtraction angiography in the follow-up of intracranial aneurysms treated with detachable coils. AJNR Am J Neuroradiol. 2005;26(6):1349–56.

  13. Möhlenbruch MA, Herweh C, Jestaedt L, Stampfl S, Schönenberger S, Ringleb PA, Bendszus M, Pham M. The FRED flow-diverter stent for intracranial aneurysms: clinical study to assess safety and efficacy. AJNR Am J Neuroradiol. 2015;36(6):1155–61.

  14. Wakhloo AK, Lylyk P, de Vries J, Taschner C, Lundquist J, Biondi A, Hartmann M, Szikora I, Pierot L, Sakai N, Imamura H, Sourour N, Rennie I, Skalej M, Beuing O, Bonafé A, Mery F, Turjman F, Brouwer P, Boccardi E, Valvassori L, Derakhshani S, Litzenberg MW, Gounis MJ; Surpass Study Group. Surpass flow diverter in the treatment of intracranial aneurysms: a prospective multicenter study. AJNR Am J Neuroradiol. 2015;36(1):98–107.

  15. Klisch J, Sychra V, Strasilla C, Liebig T, Fiorella D. The Woven EndoBridge cerebral aneurysm embolization device (WEB II): initial clinical experience. Neuroradiology. 2011;53(8):599–607.

  16. Liebig T, Kabbasch C, Strasilla C, Berlis A, Weber W, Pierot L, Patankar T, Barreau X, Dervin J, Kuršumović A, Rath S, Lubicz B, Klisch J. Intrasaccular flow disruption in acutely ruptured aneurysms: A multicenter retrospective review of the use of the WEB. AJNR Am J Neuroradiol. 2015;36(9):1721–7.

  17. Lubicz B, Klisch J, Gauvrit JY, Szikora I, Leonardi M, Liebig T, Nuzzi NP, Boccardi E, Paola FD, Holtmannspötter M, Weber W, Calgliari E, Sychra V, Mine B, Pierot L. WEB-DL endovascular treatment of wide-neck bifurcation aneurysms: short- and midterm results in a European study. AJNR Am J Neuroradiol. 2014;35(3):432–8.

  18. Pierot L, Liebig T, Sychra V, Kadziolka K, Dorn F, Strasilla C, Kabbasch C, Klisch J. Intrasaccular flow-disruption treatment of intracranial aneurysms: preliminary results of a multicenter clinical study. AJNR Am J Neuroradiol. 2012;33(7):1232–8.

  19. Horowitz M, Levy E, Sauvageau E, Genevro J, Guterman LR, Hanel R, Wehman C, Gupta R, Jovin T. Intra/extra-aneurysmal stent placement for management of complex and wide-necked-bifurcation aneurysms: eight cases using the waffle cone technique. Neurosurgery. 2006;58(4 Suppl 2):ONS-258-62; discussion ONS-262.

  20. Limbucci N, Renieri L, Nappini S, Consoli A, Rosi A, Mangiafico S. Y‑stent assisted coiling of bifurcation aneurysms with Enterprise stent: long-term follow-up. J Neurointerv Surg. 2016;8(2):158-62.

  21. Liu W, Kung DK, Policeni B, Rossen JD, Jabbour PM, Hasan DM. Stent-assisted coil embolization of complex wide-necked bifurcation cerebral aneurysms using the “waffle cone” technique. A review of ten consecutive cases. Interv Neuroradiol. 2012;18(1):20–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Padalino DJ, Singla A, Jacobsen W, Deshaies EM. Enterprise stent for waffle-cone stent-assisted coil embolization of large wide-necked arterial bifurcation aneurysms. Surg Neurol Int. 2013;4:9.

  23. Park HR, Yoon SM, Shim JJ, Kim SH. Waffle-cone technique using solitaire AB stent. J Korean Neurosurg Soc. 2012;51(4):222–6.

  24. Aguilar-Pérez M, Kurre W, Fischer S, Bäzner H, Henkes H. Coil occlusion of wide-neck bifurcation aneurysms assisted by a novel intra- to extra-aneurysmatic neck-bridging device (pCONus): initial experience. AJNR Am J Neuroradiol. 2014;35(5):965–71.

  25. Gory B, Aguilar-Pérez M, Pomero E, Turjman F, Weber W, Fischer S, Henkes H, Biondi A. pCONus device for the endovascular treatment of wide-neck middle cerebral artery aneurysms. Ajnr Am J Neuroradiol. 2015;36(9):1735–40.

  26. Lubicz B, Morais R, Alghamdi F, Mine B, Collignon L, Eker OF. The pCONus device for the endovascular treatment of wide neck bifurcation aneurysms. J Neurointerv Surg. 2016;8(9):940-4.

  27. Mpotsaris A, Henkes H, Weber W. Waffle Y technique: pCONus for tandem bifurcation aneurysms of the middle cerebral artery. J Neurointerv Surg. 2014;6(10):e51.

  28. Fischer S, Weber A, Titschert A, Brenke C, Kowoll A, Weber W. Single-center experience in the endovascular treatment of wide-necked intracranial aneurysms with a bridging intra-/extra-aneurysm implant (pCONus). J Neurointerv Surg. 2015 Dec 9. pii: neurintsurg-2015-012004. doi: 10.1136/neurintsurg-2015-012004. [Epub ahead of print]

Download references

Author information

Authors and Affiliations

  1. Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    C. Ulfert, J. Pfaff, C. Herweh, M. Pham, M. Bendszus & M. Möhlenbruch

  2. Department of Neurology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    S. Schönenberger & J. Bösel

Authors
  1. C. Ulfert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Pfaff
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Schönenberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Bösel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Herweh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Pham
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Bendszus
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M. Möhlenbruch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Möhlenbruch.

Ethics declarations

Conflict of Interests

C. Ulfert has received travel expenses from Bayer, Codman, Microvention and Stryker. J. Pfaff has received travel expenses from Siemens and Stryker. J. Bösel has received honoraria and travel expenses from Bard, Zoll, Seiratherm and Sedana Medical. M. Pham has received speaker fees and reimbursement of travel expenses from Penumbra, Covidien and Bayer. M. Bendszus has received fees and is consultant for Guerbet, Novartis, Codman and Roche. M. Möhlenbruch has received fees and is consultant for Acandis, Codman, Microvention, and Phenox and S. Schönenberger states that he has no conflict of interests.

Ethical standards

All investigations described in this manuscript were carried out in accordance with national law and the Helsinki Declaration of 1975 (in its current revised form). Ethics approval was obtained from the ethics committee of the University of Heidelberg. Informed consent was obtained from all patients included in the study or the legal representative.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ulfert, C., Pfaff, J., Schönenberger, S. et al. The pCONus Device in Treatment of Wide-necked Aneurysms. Clin Neuroradiol 28, 47–54 (2018). https://doi.org/10.1007/s00062-016-0542-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00062-016-0542-z

Keywords

Search

Navigation