Background While there have been technical advances in endovascular treatment options for a wide variety of intracranial aneurysms not all aneurysms are suitable for coil embolization. Wide neck aneurysms at a bifurcation have remained technically challenging and coil retention is a valid concern. However, the PulseRider® (Pulsar Vascular, San Jose, CA USA) was recently introduced as an adjunctive device specifically designed to provide a scaffold at the neck of bifurcation aneurysms.
The technology is specifically designed for complex bifurcations aneurysms to provide neck reconstruction and coil support. It provides coverage only where it is needed allowing for a low metal to artery ratio; this along with intraluminal patency is a significant advantages over current Y-stenting.
Methods This is a review of data on eight (8) patients that had anterior and two (2) that had posterior circulation aneurysms. There were eight (8) females and two (2) males and the average age was 51 (range 41 to 62). The aneurysms were referred to as wide-neck when the dome/neck ratio was 1.5 and/or neck length was 4 mm.
Results Overall, 10 patients were treated with the PulseRider device. Of the 10 patients treated two (2) had basilar artery aneurysms that had ruptured more than six (6) years prior and required retreatment. One patient had subarachnoid hemorrhage prior to treatment of a ruptured basilar apex and left middle cerebral artery (MCA) aneurysms but treatment with the PulseRider was for a right unruptured MCA. One patient with an Acom that had ruptured and was treated six (6) months prior had recurrence on follow-up. An unsuccessful attempted clipping was followed by endovascular treatment with PulseRider and coils. One other patient had residual aneurysm on one (1) week follow-up angiogram post craniotomy and was then treated with PulseRider and coils.
All but one patient were started on dual anti-platelet therapy (Aspirin and Clopidogrel) prior to endovascular treatment. Because a decision was made to use the PulseRider intra-operatively in one patient there was an adjustment in heparin dosage and intravenous (IV) Aspirin 500 mg. was givenFollow-up angiography was done at 6 months on 2 patients and complete or near-complete (>95%) embolization was achieved in all patients and the branch vessels remained patent.
The PulseRider adapted easily to the geometry of the aneurysm and the branch vessels allowing placement inside the aneurysm, in the branch vessels or in a hybrid manner with one side of the arch in the aneurysm and the other in a branch vessel. There was technical success related to placement of the device in all cases. All procedures were completed without complications. There were no neurological deficits.
Conclusion Although this is a small series preliminary results are quite promising with good angiographic occlusion of the aneurysms. It will be necessary however, to obtain long term results on a larger series of patients in order to prove the safety and efficacy of this device as a treatment option.
Disclosures H. Nahser: 6; C; support for Travel to meetings by various companies. A. Chandran: 6; C; Travel expenses to conferences by various companies. M. Puthuran: 6; C; travel expenses to conferences by various companies. P. Eldridge: 6; C; travel expenses to conferences by various companies. T. Patankar: 6; C; travel expenses to conferences by various companies. T. Goddard: 6; C; Travel expenses to conferences by various companies.
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