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Case report
Waffle Y technique: pCONus for tandem bifurcation aneurysms of the middle cerebral artery
  1. Anastasios Mpotsaris1,
  2. Hans Henkes2,
  3. Werner Weber1
  1. 1Department of Radiology and Neuroradiology, Klinikum Vest, Recklinghausen, Germany
  2. 2Department of Diagnostic and Interventional Neuroradiology, Klinikum Stuttgart, Stuttgart, Germany
  1. Correspondence to Dr A Mpotsaris, Department of Radiology and Neuroradiology, Klinikum Vest, Dorstener Str 151, Recklinghausen 45657, Germany; anastasios.mpotsaris{at}


Broad based bifurcation aneurysms are challenging. Various endovascular techniques aim at stabilizing the coil package in the aneurysm. Among these, the waffle cone technique provides a viable alternative to Y stenting in selected cases, incorporating a less complex delivery, and the reduced inherent risk of a single stenting procedure compared with the use of two stents in Y configuration. Unlike conventional stents, the distal end of the new pCONus device opens like a blossoming flower inside of the aneurysm to facilitate the waffle cone technique. In a case with tandem unruptured broad based middle cerebral artery bifurcation aneurysms, the complex anatomical challenge was resolved by a unique combination of both techniques: two pCONus deployed in Y configuration, offering stable neck coverage for coiling both aneurysms. The angiographic results with complete occlusion of both aneurysms and the uneventful clinical course at 90 days with continued daily administration of dual antiplatelet therapy are encouraging.

  • Aneurysm
  • Angiography
  • Coil
  • Intervention
  • Technique

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