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Recent aneurysm embolization articles published in the Journal of Neurointerventional Surgery have disproportionately focused on wide neck bifurcation aneurysms (WNBA). Meta-analyses suggest that conventional WNBA treatments yield low rates of adequate occlusion and relatively high rates of complications.1 Many devices have recently been developed to address this concern including: WEB2 (Microvention, Aliso Viejo, California, USA), pCONus3 (Phenox GmbH, Bochum, Germany), Barrel VRD4 (Medtronic, Irvine, California USA), and PulseRider5 (Cerenovus, New Bruswick, New Jersey, USA). For a few of these devices, novel catheter maneuvers and skills are necessary for proper deployment. For example, PulseRider may require rotational adjustment to optimize leaf positioning either within or just outside the aneurysm neck. WEB not only requires precise aneurysm and device measurements, but also sufficient volume and a certain shape within the aneurysm dome to accommodate the fixed spherical or cylindrically shaped braided device. Use of Barrel VRD can be a challenge with a sharply angulated smaller branch originating from the aneurysm neck.
Devices that require a novel skill set coupled with finite indications may have limited long term value. A recent example was Onyx HD500 (Medtronic) for aneurysm embolization.6 …
Contributors MC contributed to drafting and final approval of the manuscript.
Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Commissioned; internally peer reviewed.