Original ArticlePulseRider for Treatment of Wide-Neck Bifurcation Intracranial Aneurysms: 6-Month Results
Introduction
In the setting of wide-necked intracranial aneurysms, balloon-assisted and stent-assisted coiling has widened the indications of endovascular treatment.1, 2 However, management of these aneurysms, especially middle cerebral artery (MCA) aneurysms, remains a matter of debate, and many institutions still use surgical clipping as the first therapeutic option. To date, with the advent of new endovascular tools, the majority of wide-necked aneurysms can be managed by endovascular approach. Three endovascular devices have been developed specifically for the treatment of such aneurysms arising at bifurcations: WEB, pCONus, and PulseRider. The WEB (Sequent Medical, Aliso Viejo, California, USA) is an intrasaccular braided-wire flow-disruptor.3, 4, 5 The pCONus (Phenox GmbH, Bochum, Germany) is a new stentlike, self-expanding nitinol implant with 4 distal petals that support the coil mass of a wide-neck lesion within the aneurysmal sac.6, 7, 8 The PulseRider (Pulsar Vascular, Los Gatos, California, USA) is a retrievable self-expanding nitinol implant bridging the aneurysm neck while retaining coils within the aneurysm. To date, 3 small series were reported on intracranial aneurysms treated with PulseRider, but anatomic follow-up was reported in only 3 patients.9, 10, 11 The aim of our study was to evaluate 6-month anatomic results in the treatment of wide-neck bifurcation aneurysms with PulseRider.
Section snippets
Methods
From June 2014 to October 2015, the clinical and angiographic outcomes of consecutive patients treated at 1 U.S. center (Charleston, South Carolina, USA) and 6 European (Lyon and Besançon, France; Firenze and Treviso, Italy; Recklinghausen, Germany; Salzburg, Austria) institutions with the PulseRider device for intracranial aneurysms were retrospectively analyzed. The decision to assist coiling with the PulseRider was made at the discretion of the senior operator. All patients were informed of
Results
A total of 19 patients (10 women and 9 men; mean age, 63 years) with 19 unruptured bifurcation aneurysms were included. One aneurysm was previously treated by coiling. Aneurysm locations and measurements are summarized in Table 1. The mean dome size was 8.8 mm (range, 3–17 mm), and mean neck size was 5.8 mm (range, 2.3–14 mm). In all cases, the aneurysm was treated with a single PulseRider without any other endovascular device except coils.
Discussion
To date, our study represents the largest series of patients with wide-necked bifurcation aneurysms treated by the PulseRider stent-assisted coiling. We reported recently immediate clinical and anatomic outcomes.10 We assess here the 6-month anatomic results of patients managed by the endovascular approach with the PulseRider.
As previously reported in our preliminary series of 15 patients,10 initial adequate occlusion was achieved in the majority of cases (89.5%) despite unfavorable anatomic
Conclusions
Endovascular therapy of wide-neck bifurcation intracranial aneurysms with PulseRider allows treatment with a high rate of adequate aneurysm occlusion at 6 months. The risk of aneurysm recanalization was low at 6 months.
References (19)
- et al.
Endovascular treatment of middle cerebral artery aneurysms for 120 nonselected patients: a prospective cohort study
AJNR Am J Neuroradiol
(2014) - et al.
Solitaire AB stent-assisted coiling of wide-necked intracranial aneurysms: short-term results from a prospective, consecutive, European multicentric study
Neuroradiology
(2013) - et al.
WEB Treatment of intracranial aneurysms: clinical and anatomic results in the French observatory
AJNR Am J Neuroradiol
(2016) - et al.
Endovascular treatment of intracranial aneurysms with the WEB device: a systematic review of clinical outcomes
AJNR Am J Neuroradiol
(2016) - et al.
One-year angiographic follow-up after WEB-SL endovascular treatment of wide-neck bifurcation intracranial aneurysms
AJNR Am J Neuroradiol
(2015) - et al.
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) - et al.
pCONus device for the endovascular treatment of wide-neck middle cerebral artery aneurysms
AJNR Am J Neuroradiol
(2015) - Gory B, Aguilar-Pérez M, Pomero E, Turjman F, Weber W, Fischer S, et al. One-year angiographic results after pCONus...
- et al.
Initial experience with the PulseRider for the treatment of bifurcation aneurysms: report of first three cases in the USA
J Neurointerv Surg
(2016)
Cited by (20)
Bifurcation Aneurysm Treatment with PulseRider: Technical Nuances, Device Selection, Positioning Strategies, and Overcoming Geometric Challenges
2020, World NeurosurgeryCitation Excerpt :Thus contained herein is a “how-to” guide for neuroendovascular surgeons less experienced with PR applications wanting to accelerate their learning curve and add this device to their armamentarium. This paper is intended to be a purely technical exposition on use of the device, without inclusion of clinical data; the authors have previously published on their extensive clinical and proctorship experience using the PR device.11-16 The PR is a self-expanding nitinol implant (Figure 1) that is delivered on a stainless-steel delivery wire within any commercially available 021 diameter (0.021″) microcatheter.
PulseRider-Assisted Coil Embolization for Treatment of Intracranial Bifurcation Aneurysms: A Single-Center Case Series with 24-Month Follow-up
2019, World NeurosurgeryCitation Excerpt :This new design is expected to decrease the risk of periprocedural risk by simpler techniques and to reduce thromboembolic complications owing to less metal burden compared with using 2 circumferential stents. Although recent case series with 6-month or 12-month follow-up have shown a safe and effective profile of PulseRider,12,14,16-19 long-term results beyond 12 months remain unknown. In this series, there were no intraprocedural or postprocedural complications related to the PulseRider.
PulseRider Use in Ruptured Basilar Apex Aneurysms
2019, World NeurosurgeryCurrent Status of the PulseRider in the Treatment of Bifurcation Aneurysms: A Systematic Review
2018, World NeurosurgeryCitation Excerpt :There was 1 recanalization reported in 1 of the multicenter case series within the 6-month follow-up. A summary of the results of these studies is shown in Table 2.8-10 This systematic review suggests that the PulseRider has a safe and effective profile at short-term follow-up.
Conflict of interest statement: Alejandro M. Spiotta's affiliations are as follows: Penumbra Consulting, honorarium, speaker bureau; Pulsar Vascular Consulting, honorarium, speaker bureau; Microvention Consulting, honorarium, speaker bureau, research; and Stryker Consulting, honorarium, speaker bureau. None of the other authors have conflicts of interest.