title: Coil occlusion of wide-neck bifurcation aneurysms assisted by a novel intra- to extra-aneurysmatic neck-bridging device (pCONus): initial experience.
abstract: OBJECTIVE
  The pCONus is a new stentlike self-expanding nitinol implant with 4 distal petals, which is fully retrievable and electrolytically detachable. The distal end is implanted inside the aneurysm at the neck. The shaft is anchored in the parent vessel. In selected wide-neck bifurcation aneurysms, the pCONus was used to assist coiling. The device was evaluated for its safety and efficacy.
  
  
  METHODS
  Twenty-eight patients with 28 wide-neck aneurysms (9 recently ruptured) were treated with pCONus-assisted coiling at the discretion of the operator. Other treatment options were considered but were discarded due to anticipated difficulties. Technical issues, immediate posttreatment angiographic findings, clinical outcome, and follow-up imaging were assessed.
  
  
  RESULTS
  There were 11 MCA, 7 anterior communicating artery, 1 posterior cerebral artery, 1 A2, and 8 basilar artery aneurysms. Insertion and deployment of the pCONus and subsequent coiling were possible in all cases. There were no clinically evident complications associated with the use of the device. Initial anatomic outcome showed 8 complete occlusions, 9 neck remnants, and 11 incomplete occlusions. Neurologic status remained unchanged at follow-up. Angiographic controls were obtained in 22 patients (mean, 7.5 months). Of these, 13 had complete occlusion, 9 showed improvement, and 7 were unchanged. Four died from SAH sequelae or other diseases, and 2 have not yet undergone follow-up. No intimal hyperplasia was observed.
  
  
  CONCLUSIONS
  The pCONus facilitates coil occlusion of unruptured and ruptured wide-neck bifurcation aneurysms. The device can be deployed safely. Coil retention is sufficient to protect the efferent vessels. So far, no intimal hyperplasia in the shaft has been observed.
authors.affiliation: From the Departments of Neuroradiology (M.A.-P., W.K., S.F., H.H.) martaaguilarperez@yahoo.es.
authors.forename: M
authors.initials: M
authors.lastname: Aguilar-Pérez
authors.affiliation: From the Departments of Neuroradiology (M.A.-P., W.K., S.F., H.H.).
authors.forename: W
authors.initials: W
authors.lastname: Kurre
authors.affiliation: From the Departments of Neuroradiology (M.A.-P., W.K., S.F., H.H.).
authors.forename: S
authors.initials: S
authors.lastname: Fischer
authors.affiliation: Neurology (H.B.), Klinikum Stuttgart, Stuttgart, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Bäzner
authors.affiliation: From the Departments of Neuroradiology (M.A.-P., W.K., S.F., H.H.).
authors.forename: H
authors.initials: H
authors.lastname: Henkes
mesh_terms: D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D055119:Elastic Modulus; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D061185:Mechanical Thrombolysis / Q000009:adverse effects / Q000295:instrumentation*; D008875:Middle Aged; D010865:Pilot Projects; D011474:Prosthesis Design; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome