The pCONus Device for Treatment of Complex Wide-Neck Anterior Communicating Artery Aneurysms.

Abstract

Anterior communicating artery (AcomA) aneurysms with a wide neck are often not feasible for endovascular coiling. Emerging devices for neck protection, such as the pCONus stent, are promising for endovascular treatment of challenging intracranial aneurysms. We report the preliminary results with pCONus in the treatment of wide-neck AcomA aneurysms. All consecutive patients harboring AcomA aneurysms treated with pCONus in 3 European centers were retrospectively reviewed. Thirty-six patients (mean age, 61 years) harboring 36 saccular AcomA aneurysms (mean dome size, 7.3 mm; mean neck size, 5.4 mm) were included, of which 7 were treated in the setting of subarachnoid hemorrhage. A procedural angiographic complication was reported in 3 patients without clinical impact at 3 months. Five patients presented a postoperative neurological deficit without angiographic complication. Procedure-related permanent morbidity and mortality rates were 11% (3/33) and 0 at 3 months, respectively. Postoperative angiographic results showed a complete aneurysm occlusion in 56% (20/36), a neck remnant in 25% (9/36), and an aneurysm remnant in 19% (7/36) of cases. Four patients were retreated after early angiographic follow-up (mean, 3.2 months). Twenty-two patients were followed (mean, 12.9 months), and a complete aneurysm occlusion was observed in 59% of patients (13/22), and a neck remnant in 41% (9/22). There was no in-stent stenosis or jailed branch occlusion. Recanalization rate was 9%. The pCONus device allows endovascular coiling of wide-necked AcomA aneurysms.