pCONus Device for the Endovascular Treatment of Wide-Neck Middle Cerebral Artery Aneurysms

BACKGROUND AND PURPOSE:Endovascular treatment of bifurcation middle cerebral artery aneurysms with a wide neck could be challenging, and many lesions are still treated by a surgical approach. The pCONus is a newly emerging device for wide-neck bifurcation intracranial aneurysms. To date, a single report on the treatment of intracranial aneurysms including all locations has been published. We report our experience with pCONus in the treatment of wide-neck MCA aneurysms.MATERIALS AND METHODS:MCA aneurysms treated with pCONus in 4 European centers were retrospectively reviewed.RESULTS:Forty MCA aneurysms (mean dome size, 7.7 mm; mean neck size, 5.6 mm) were treated in 40 patients (mean age, 62 years). Aneurysm coiling was performed after deployment of 1 pCONus in 95% (38/40) of cases and after deployment of 2 pCONus devices in 5% (2/40). No procedural angiographic complications were observed. Reversible neurologic complications were noted in 5% (2/40), and permanent neurologic complication, in 2.5% (1/40) at 1 month. There was no mortality. No aneurysms bled or rebled after treatment. Immediate angiographic results were complete aneurysm occlusion in 25% (10/40), neck remnant in 47.5% (19/40), and aneurysm remnant in 27.5% (11/40). Follow-up (mean, 6.8 months) was available for 33 aneurysms (82.5%). Stable or improved results were observed in all except 3 cases, including 48.5% complete occlusions (16/33), 30.3% neck remnants (10/33), and 21.2% aneurysm remnants (7/33). There was no in-stent stenosis or jailed branch occlusion. There was no angiographic recurrence of initially totally occluded aneurysms.CONCLUSIONS:MCA aneurysms with a wide neck are amenable to treatment with pCONus.

Although the superiority of endovascular treatment compared with surgery appears unaffected by aneurysm location in the randomized International Subarachnoid Aneurysm Trial,¹ management of middle cerebral artery aneurysms remains a matter of debate. Nevertheless many institutions still use surgical clipping as the first treatment for MCA aneurysms.^2,3 Balloon and stent-assisted techniques have widened the indications for endovascular treatment of MCA aneurysms with a wide neck and/or unfavorable anatomy that were otherwise unsuitable for coiling.^4,5 However, the risk of procedure-related morbidity and mortality is not negligible, especially with double-stent placement in Y and X configurations.^4,6,7 The widespread adoption of endovascular treatment for MCA aneurysms with unfavorable anatomy requires an improvement of the safety of the endovascular approach. A new device, the pCONus aneurysm implant (phenox, Bochum, Germany), has recently been developed to improve the safety of endovascular treatment of these challenging aneurysms. To date, a single published article on intracranial aneurysms treated with pCONus reported a series including some cases of MCA aneurysms.⁸ The aim of this study was to evaluate the results in the treatment of wide-neck MCA aneurysms with the pCONus device.