gms | German Medical Science

Objective: Wide-necked bifurcation aneurysms (WNBA) are considered to belong to the subgroup of aneurysms with increased difficulty and risks. A variety of devices for the treatment of these aneurysms recently became available. pCONus1 (phenox) consists of an electrolytically detachable laser cut stent with a straight shaft and a distal crown with four petals. The distal end of the device is deployed inside the aneurysm sac with the petals at the level of the aneurysm neck. Our purpose is to present the largest series of patients treated with this device in a single center with special focus on the safety and occlusion stability.

Methods: 146 consecutive patients with 150 wide-necked bifurcation aneurysms underwent endovascular treatment using pCONus1 between February, 2012 and September, 2017 in a single center. We retrospectively evaluated the angiographic results at the end of the procedure and at follow-up, the clinical status and complications.

Results: Aneurysm locations were internal middle cerebral artery (n=74), anterior communicating artery (n=40), basilar tip (n=28), A2 bifurcation (n=3), carotid artery bifurcation (n=2), A2 trifurcation (n=1), basilar artery fenestration (n=1), and posterior cerebral artery (n=1). Twenty-eight patients were treated in the setting of acute subarachnoid hemorrhage. Successful treatment with the pCONus was achieved in all but four cases. In 7 aneurysms deployment of the pCONus and coil occlusion of the aneurysm were performed in 2 different sessions. One aneurysm ruptured during the treatment without permanent deficit for the patient. Immediate angiographic results were modified Raymond-Roy classification (mRRC) I=62, mRRC II=44, mRRC III=40. Follow-up angiography was available in 131 aneurysms, with 116 (88%) showing sufficient occlusion. During the follow-up period a total of 28 aneurysms were retreated. Intimal hyperplasia in the stented segment of the parent artery or device migration has not been observed to date.

Conclusion: pCONus allows controlled coil occlusion of WNBA, both ruptured and unruptured. pCONus facilitates initial coil insertion and retreatment as well. Major complications are rare.