Article Figures & Data
Figures
- Figure 1
Working projection for proper deployment of the pCONUS HPC device in an incidental wide-necked middle cerebral artery (MCA) bifurcation aneurysm on the right side (A). Positioning of a 4-15-10 mm pCONUS2 HPC with correct expansion of the four petals by the arrangement of the radiopaque markers (B). Diffusion-weighted imaging obtained the following day showed small high signal intensity spots in the right postcentral gyrus (C). Working projection for coil occlusion of the aneurysm 7 days after pCONUS HPC implantation (D). After complete embolisation of the aneurysm, a non-occlusive thrombus was observed at the neck of the aneurysm and superior branch of the MCA (E, arrow). Final run after a weigh-adapted bolus of eptifibatide with nearly complete thrombus removal (F).
- Figure 2
Three-dimensional reconstruction showing a wide-necked middle cerebral artery (MCA) bifurcation aneurysm on the left side (A). Positioning of a 4-15-15 mm pCONUS2 HPC via a 21-inch microcatheter within the aneurysm under acetylsalicylic acid (ASA) as single antiplatelet therapy (B). Diffusion-weighted imaging (DWI) obtained the following day showed a single high signal intensity (HSI) spot in the left precentral gyrus (C). DWI obtained at the time of the second treatment showed multiple new HSI spots (D). Patient had stopped the medication without consultation. VerifyNow confirmed insufficient inhibition (ARU:513). After administration of 500 mg ASA intravenous, coil occlusion was performed 7 days after the pCONUS HPC implantation. After coiling, a non-occlusive thrombus at the superior branch of the left MCA was observed (E, circle). Final run after an intravenous weigh-adapted bolus of eptifibatide showing its nearly complete disappearance (F). DWI obtained the following day showing no new HSI spots (compare D and G). Follow-up performed 163 days after treatment showed reperfusion of the aneurysm, which needed retreatment (H).
- Figure 3
Posterior−anterior view of the right internal carotid artery showing an incidental wide-necked anterior communicating artery aneurysm (A). Three-dimensional reconstruction showing the aneurysm with a neck width of 5 mm (B). Dyna-CT reconstruction showing the position of a 4-15-6 mm pCONUS2 HPC within the aneurysm and along the right A1 segment (C). Procedure was performed under acetylsalicylic acid (ASA) as single antiplatelet therapy. Working projection for coil occlusion of the aneurysm 39 days after pCONUS HPC implantation (D). Final run after coiling of the aneurysm with small neck remnant visible (E). No high signal intensity spots were observed in the diffusion-weighted imaging performed the following day. Follow-up angiogram 8 months after coil occlusion (F,G) showed complete occlusion of the aneurysm and severe intimal hyperplasia along the stent-shaft (compare D and H). VerifyNow confirmed insufficient inhibition for ASA (ARU:569).
Tables
- Table 1
Aneuryms size, location and antiplatelet regimen
Patient number Location Laterality Neck width (mm) Fundus width (mm) Fundus height (mm) Clinical presentation Initial mRS Daily APT prior treatment (mg) Daily APT after treatment (mg) 1 AcomA Midline 5 4 12 Incidental 0 1×100 ASA 1×100 ASA 2 AcomA Midline 5 5 6,5 Incidental 0 2×100 ASA 2×100 ASA 3 AcomA Midline 5.3 5.5 3.5 Incidental 0 2×100 ASA
2×150 Dabigatran2×100 ASA
2×150 Dabigatran4 MCA L 7.5 14 12 Incidental 0 500 ASA 500 ASA 5 MCA R 4.8 8 9 Incidental 0 2×100 ASA 2×100 ASA 6 Basilar tip Midline 5.7 7.5 8.7 Incidental 1 2×100 ASA 2×100 ASA 7 MCA R 7.1 11 12 Incidental 1 2×100 ASA 2×100 ASA
*2×90 Ticagrelor8 MCA R 7 10.5 9.5 Incidental 0 2×100 ASA 2×100 ASA 9 MCA R 3.6 3.5 4 Incidental 0 2×100 ASA 2×100 ASA 10 PcomA R 4 5 6 Incidental 0 2×100 ASA 2×100 ASA 11 AcomA Midline 4.4 4 4.6 Incidental 0 1×500 ASA 2×100 ASA 12 Basilar tip Midline 8 9 12 Incidental 0 2×100 ASA 2×100 ASA 13 AcomA L 6 6 6.5 Incidental 0 2×100 ASA 2×100 ASA 14 MCA R 5.6 5.6 9.9 Incidental 1 2×100 ASA 2×100 ASA 15 MCA R 2.3 2.6 3 Incidental 1 2×100 ASA 2×100 ASA *added for the reconstruction of the dissected ICA
AcomA, anterior communicating artery; APT, antiplatelet therapy; ASA, acetylsalicylic acid; L, left; MCA, middle cerebral artery; PcomA, posterior communicating artery; R, right.
- Table 2
Clinical and radiographic outcome
Patient number pCONUS HPC Complications during stenting DWI #1 Time between stent and coiling (days) Complications during coiling DWI #2 mRRC mRS at discharge Time to FU (days) mRRC at FU mRS at FU 1 PCON2-4-15-7 – + 37 – – II 0 394 II 0 2 PCON2-4-15-6 – NA 39 – – II 0 332 I 0 3 PCON2-4-15-6 – + 40 – + II 0 146 II 0 4 PCON2-4-15-15 – + 7 Thrombus + I 0 163 IIIB 0 5 PCON2-4-15-6 – + 10 – + I 0 324 I 0 6 PCON2-4-15-7 – + 48 – – II 1 NA NA 6 7 PCON2-4-15-7 ICA-Dissection + 2 – + IIIA 1 173 I 0 8 PCON2-4-15-10 – + 7 Thrombus + IIIB 0 91 I 0 9 PCON-3-20-4 – – 44 – – I 0 224 I 0 10 PCON2-4-15-6 – + 42 + I 0 NA NA NA 11 PCON-3-20-4 – + 106 – NA I 2 NA NA NA 12 PCON2-4-15-8 – + 41 – – IIIA 0 77 II 0 13 PCON2-4-15-7 – + 57 – IIIB 0 NA NA NA 14 PCON2-4-15-6 – + 39 Thrombus + IIIA 1 88 IIIA 0 15 PCON-3-20-4 – + 40 Thrombus + IIIB 1 NA NA NA DWI, diffusion-weighted imaging; FU, follow-up; ICA, internal carotid artery; mRRC, modified Raymond-Roy classification; mRS, modified Rankin Scale.
