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Original research
Use of the pCONus HPC as an adjunct to coil occlusion of acutely ruptured aneurysms: early clinical experience using single antiplatelet therapy
  1. Marta Aguilar Perez1,
  2. Muhammad AlMatter1,
  3. Victoria Hellstern1,
  4. Christina Wendl2,
  5. Oliver Ganslandt3,
  6. Hansjörg Bäzner4,
  7. Hans Henkes1,5
  1. 1 Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, Germany
  2. 2 Institut für Röntgendiagnostik, Zentrum für Neuroradiologie, Universitatsklinikum Regensburg, Regensburg, Bayern, Germany
  3. 3 Neurochirurgische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, Germany
  4. 4 Neurologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, Germany
  5. 5 Medizinische Fakultät der Universität Duisburg-Essen, Essen, Germany
  1. Correspondence to Dr Marta Aguilar Perez, Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart 70174, Baden-Württemberg, Germany; martaaguilarperez{at}yahoo.es

Abstract

Background Coil occlusion has become the standard treatment for many ruptured aneurysms. However, specific aneurysm structures pose technical difficulties and may require the use of adjunctive neck-bridging devices, which necessitate the use of dual antiplatelet therapy. The hydrophilic polymer coating (pHPC, phenox) is a surface modification that inhibits platelet adhesion.

Objective To present initial experience with the pCONUS HPC device as an adjunct to coil embolization for ruptured aneurysms using single antiplatelet therapy (SAPT).

Methods All patients who were treated with the pCONUS HPC for ruptured aneurysms using SAPT were retrospectively identified. The occurrence of thromboembolic and hemorrhagic complications was recorded together with the angiographic and clinical follow-up details.

Results Fifteen patients were identified (nine female) with a median age of 54 years (range 27–81). Six aneurysms were located at the anterior communicating artery, five at the middle cerebral artery bifurcation, two at the basilar artery bifurcation, one at the posterior communicating artery, and one involving the intradural internal carotid artery. Ten patients (66.6%) achieved modified Raymond–Roy classification I or II at post-treatment angiography, with 45.5% of patients having adequate occlusion (defined as complete occlusion or neck remnant) at follow-up. All patients received acetylsalicylic acid (ASA) as SAPT before and after the procedure. Intraprocedural thrombus formation was seen in three patients (20%), resolving in two patients after a bolus dose of eptifibatide, and one treated with mechanical aspiration. No clinical or radiological consequences were seen. There were no recurrent aneurysm ruptures. One patient died owing to cerebral vasospasm.

Conclusion This initial clinical experience highlights the possibility and limitations of using the pCONUS HPC device in the treatment of complex ruptured aneurysm with ASA as SAPT. Randomized trials with longer follow-up in larger cohorts are underway.

  • aneurysm
  • coil
  • device
  • intervention
  • stent
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Twitter @marta__aguilar

  • Contributors Conceptualization: MAP, HH. Data collection: MAP, MA, VH. Investigation: MAP, MA, VH. Supervision: HB, OG, HH. Angiographic results assessment: CW. Writing – original draft: MAP, HH. Writing – review, editing: CW, OG, HB, HH.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MAP and VH have a consulting agreement with phenox GmbH. HH is co-founder and shareholder of phenox GmbH.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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