Article Figures & Data
Figures
- Fig 1.
Detachment mechanism of the p64. Eight bundles, each containing 8 wires, are attached to a slotted crown (A) and released from there by pulling a polymer hypotube in the proximal direction (B). Image courtesy of phenox.
- Fig 2.
Manual detachment of the p64. The p64 comes with a torque device, which is locked over the hypotube to hold this hypotube in position (A). The detachment starts with unlocking the torquer, repositioning it, and again locking it approximately 15 mm proximally (B). A handle on the hypotube is then moved proximally (C).
- Fig 3.
De novo unruptured paraclinoid aneurysm (7 × 5 mm) in a 63-year-old woman with a history of 2 spontaneous SAHs from 2 MCA bifurcation aneurysms, which had been clipped. The paraclinoid aneurysm was not considered ideal for coil occlusion alone (A), and the patient was reluctant to undergo surgery again. A single Morpheus 7 × 21 cm 3D coil (Medtronic, Dublin, Ireland) was inserted into the aneurysm. The aneurysm neck was then covered by a 4 × 18 mm p64 (B). DSA follow-up 93 days later reveals complete occlusion of the aneurysm (C).
- Fig 4.
A small saccular aneurysm of the basilar trunk (4 × 3 mm) (A) in a 56-year-old woman. Both surgery and coil occlusion were not considered suitable treatment options. A 4.5 × 15 mm p64 was deployed in the basilar artery with complete coverage of the aneurysm (B). Although the procedure was well-tolerated, the patient developed a hemiparesis and dysarthria (mRS 3) 26 days later. MR imaging shows an ischemic pontine lesion (C); a Multiplate test (not shown) confirmed insufficient platelet function inhibition. Antiaggregation was switched to ticagrelor, and the patient subsequently recovered (mRS 1). Follow-up DSA after 28 days (D) and after 421 days (E) shows complete occlusion of the aneurysm.
Tables
- Table 1:
Inclusion and exclusion criteria for the presented series of patients treated with p64
Criteria for the p64 Treatment and Analysis in this Series Inclusion Intracranial saccular sidewall aneurysm as treatment target Aneurysms unruptured or at least not in the acute phase after rupture Extra- or intradural symptomatic aneurysm Asymptomatic intradural aneurysms, thus carrying a potential risk of intracranial rupture Anticipated difficulty of coil or clip treatment (eg, complex aneurysm morphology, wide neck, dome-to-neck ratio of <1.2, small size, difficult surgical access) No previous treatment or any previous treatment directed at the aneurysm sac without complete occlusion of the aneurysm from circulation No previous treatment to the parent vessel An ability and willingness of the patient to take the necessary medication for midterm dual platelet function inhibition Exclusion Bifurcation-type aneurysm or fusiform vessel dilation as a treatment target Implants other than p64 used Aneurysm rupture ≤30 days prior to the p64 treatment Extradural asymptomatic aneurysm Anticipated ease or sufficiency of clip or coil treatment Previous implantation of stents or flow diverters to the target-vessel segment - Table 2:
Breakdown of aneurysm occlusion rate and complication incidence according to the size of the aneurysm fundus
Fundus Diameter 1–3 mm (n = 59) 4–6 mm (n = 42) 7–9 mm (n = 15) >10 mm (n = 14) Early follow-up 55/59 (93%) 42/42 (100%) 15/15 (100%) 12/14 (85.7%) Complete occlusion 31 (56.4%) 28 (66.7%) 9 (60%) 4 (33.3%) Neck remnant 13 (23.6%) 4 (9.5%) 2 (13%) 7 (58.3%) Sac remnant 7 (12.7%) 5 (11.9%) 3 (20%) 1 (8.3%) Unchanged 4 (7.3%) 4 (9.5%) 1 (6.7%) 0 Midterm follow-up 46/59 (78%) 34/42 (81%) 11/15 (73.3%) 8/14 (57.1%) Complete occlusion 37 (80.4%) 26 (76.5%) 9 (81.8%) 4 (50%) Neck remnant 3 (6.5) 5 (14.7%) 2 (18.2%) 3 (37.5%) Sac remnant 4 (8.7%) 2 (5.9%) 0 1 (12.5%) Unchanged 2 (4.3%) 1 (2.9%) 0 0 Complications 1 Pontine ischemia 1 Pontine ischemia 1 TIA 1 Death 1 CN VI palsy 1 TIA 1 Asymptomatic thrombosis 1 Pulmonary artery occlusion 1 Asymptomatic thrombosis Note:—CN indicates cranial nerve.
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