An Update on the Adjunctive Neurovascular Support of Wide-Neck Aneurysm Embolization and Reconstruction Trial: 1-Year Safety and Angiographic Results

Spiotta, A; Chaudry, Imran; Turner, Raymond D; Turk, Aquilla S; Derdeyn, Colin P.; Mocco, J; Tateshima, Satoshi

doi:10.3174/ajnr.a5599

Cited by 28 publications

(16 citation statements)

References 27 publications

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“…The rate of permanent neurologic deficits in the periprocedural period was 0%. We recognize that the incidence of complications is not zero in our patient group, but is an improvement from conventional endovascular methods and also similar to recent devices reported in literature ( 17 – 19 ).…”

Section: Complicationssupporting

confidence: 86%

Endosurgical Remodeling of Wide-Necked Bifurcation Aneurysms

et al. 2019

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Background: Wide-necked cerebral aneurysms at a bifurcation can be difficult to treat with endovascular techniques despite recent advancements.Objective: We describe a new technique of micro-scaffold remodeling of the aneurysm neck of wide-necked bifurcation aneurysms by placing one or more microcatheters and/or wires in the efferent vessels. We hypothesize that this technique would be a better choice to change the branch angulation, allowing for an improved configuration to stably deploy coils. We present a retrospective case series to illustrate this technique.Methods: 17 wide-necked bifurcation aneurysms in 17 patients were coil embolized using this technique during a 3 year study period. Branch-vessel microcatheters and/or microwires were used to remodel the aneurysm neck and support the coil mass. Statistical analysis of the branch angulation and neck-width changes were performed during treatment. Long-term clinical outcome and follow-up angiography was obtained in 8 patients.Results: Eleven patients had complete occlusion of their aneurysm (Raymond-Roy Class I), and 6 patients had Raymond-Roy Class 2 immediately after treatment. Efferent vessels demonstrated a statistically significant change in angulation with insertion of microcatheters or microwires, while neck width did not change significantly. There were four intraoperative complications and no neurological morbidity in the immediate post-operative period. Complete occlusion was documented for all 10 subjects with long-term follow-up.Conclusions: The micro-scaffold endosurgical remodeling technique is a useful adjunct in treating wide-necked bifurcation aneurysms. By elevating branch vessels away from the aneurysm neck, this technique allows for dense coil packing while decreasing the need for balloon or stent assistance.

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Section: Complicationssupporting

confidence: 86%

Endosurgical Remodeling of Wide-Necked Bifurcation Aneurysms

et al. 2019

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“…Large multicenter studies have allowed for the treating surgeon to follow with their imaging modality of choice. 2,3 This case report implies that MRA is appropriate for follow-up aneurysms but not necessarily the parent vessel.…”

Section: Discussionmentioning

confidence: 84%

“…Endovascular treatment of widenecked cerebral aneurysms with the PulseRider has a high technical success rate, and there is complete occlusion of approximately two-thirds of aneurysms at one-year after treatment and adequate occlusion of 90% at one-year. 2,3 Additionally, the PulseRider is composed of less metal than a traditional stent with larger fenestrations, which may allow for easier coiling.…”

Section: Introductionmentioning

confidence: 99%

PulseRider Treated Aneurysm with Significant Artifact on Postoperative Magnetic Resonance Angiography: A Case Report and Literature Review

2021

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The PulseRider is a neuroendovascular adjunct for wide-necked intracranial aneurysms. The decreased metal burden of the PulseRider theoretically reduces artifact on radiologic imaging. However, we report here on a case of a patient who underwent PulseRider-assisted stent-coiling of a basilar tip aneurysm. He returned 19 months later for intermittent diplopia and darkening of vision but was neurologically intact on exam. Both contrast-enhanced and time-of-flight magnetic resonance angiography (MRA) demonstrated absence of signal in the basilar artery in the proximal anchors of the PulseRider. Given his lack of reproducible symptoms and high functional status, it is presumed that the imaging reflected artifact and not thrombosis/stenosis. Although the PulseRider is a useful treatment option for wide-necked intracranial aneurysms, the clinician should be aware that even contrast-enhanced MRA can produce artifact that resembles thrombosis/stenosis. Non-angiogram radiologic imaging modalities may be appropriate for evaluation for residual aneurysm but not patency of the parent artery.

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“…We included six studies in the qualitative and quantitative syntheses (Figure 1). There were a total of 157 subjects from six studies 4,5,7–10 (Table 1). Out of these studies, one was a retrospective cohort study, two were single-arm registries, one was a single-arm clinical trial, and two were case series.…”

Section: Resultsmentioning

confidence: 99%

“…Pulserider is a versatile device and can be positioned within the wings of daughter branches, this device also has a lower metal-to-artery ratio, which prevents jailing of daughter branches. 5,6 This systematic review and meta-analysis aim to assess the efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm—A systematic review and meta-analysis

et al. 2020

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Objective PulseRider is a novel self-expanding nickel-titanium (nitinol) stent for treatment of wide-necked aneurysms, which is commonly located at the arterial branches in the brain. This systematic review and meta-analysis aims to assess the efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm. Method We performed a systematic literature search on articles that evaluate the efficacy and safety of PulseRider-assisted coiling of the wide-necked aneurysm from several electronic databases. The primary endpoint was adequate occlusion, defined as Raymond-Roy Class I + Raymond-Roy Class II upon immediate angiography and at six-month follow-up. Results There were a total of 157 subjects from six studies. The rate of adequate occlusion on immediate angiography was 90% (95% CI, 85%–94%) and 91% (95% CI, 85%–96%) at six-month follow-up. Of these, Raymond-Roy Class I can be observed in 48% (95% CI, 41%–56%) of aneurysms immediately after coiling, and 64% (95% CI, 55%–72%) of aneurysms on six-month follow-up. Raymond-Roy Class II was found in 30% (95% CI, 23%–37%) of aneurysms immediately after coiling, and 25% (17–33) after six-month follow-up. Complications occur in 5% (95% CI, 1%–8%) of the patients. There were three intraoperative aneurysm rupture, three thrombus formation, three procedure-related posterior cerebral artery strokes, one vessel dissection, and one delayed device thrombosis. There was no procedure/device-related death. Conclusions PulseRider-assisted coiling for treatment of patients with wide-necked aneurysm reached 90% adequate occlusion rate that rises up to 91% at sixth month with 5% complication rate.

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An Update on the Adjunctive Neurovascular Support of Wide-Neck Aneurysm Embolization and Reconstruction Trial: 1-Year Safety and Angiographic Results

Cited by 28 publications

References 27 publications

Endosurgical Remodeling of Wide-Necked Bifurcation Aneurysms

Endosurgical Remodeling of Wide-Necked Bifurcation Aneurysms

PulseRider Treated Aneurysm with Significant Artifact on Postoperative Magnetic Resonance Angiography: A Case Report and Literature Review

Efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm—A systematic review and meta-analysis

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