Purpose The recently available Penumbra Coil 400 has 400% the volume per unit length of a 10-size coil due to its 0.020″ primary diameter, double that of conventional 10-coils. The Penumbra Coil 400 also purports to be softer than an equivalent 10-coil due to the larger primary diameter. This case report investigates these claims through two aneurysms treated in the same patient with two different coil systems.
Methods and Materials A 53-year-old female presented with acute onset left 3rd nerve palsy. Her history was notable for clipping of a right posterior communicating artery aneurysm 18 years prior. She was found to have a 7.4×5.0×5.0 mm (97 mm3) basilar artery bifurcation aneurysm and a 12.7×11.2×10.8 mm (804 mm3) anterior communicating artery (Acomm) aneurysm. The basilartip aneurysm was accessed with an Eschelon-10 microcatheter (Covidien, Dublin, Ireland) and embolized with five GDC-10 coils (Stryker, Kalamazoo, Michigan, USA):5 mm×15 cm, 4 mm×6 cm, 3 mm×8 cm, 2 mm×6 cm and 2 mm×4 cm. The coiling endpoint was catheter kick-out. 7 days later, the Acomm aneurysm was accessed with a PX400 microcatheter (Penumbra, Inc., Alameda, California, USA) and embolized with eight Penumbra coils: 10 mm ×40 cm, 8 mm×20 cm and 5 mm×10 cm complex standard, 4 mm×8 cm and 3 mm×10 cm complex soft, 3 mm×6 cm, 2 mm×3 cm and 2 mm×2 cm helical extra soft. The coiling endpoint was catheter kickout.
Results Procedure results for both aneurysms are shown below. There were no technical or clinical complications with either procedure.
Conclusions The Penumbra Coil 400 filled a large aneurysm to adequate packing density in about the same overall time and use of fluoroscopy as a smaller aneurysm treated with 10-size coils, despite the Penumbra-treated aneurysm being 8.3 times larger by volume. Follow-up will be required to assess the durability of occlusion in both aneurysms.
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