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Soumya Mukherjee, Arun Chandran, Anil Gopinathan, Mani Putharan, Tony Goddard, Paul R. Eldridge, Tufail Patankar and Hans-Christean Nahser

T he International Subarachnoid Aneurysm Trial (ISAT) 26 and the Barrow Ruptured Aneurysm Trial (BRAT) 25 have established endovascular therapy as a valid method for treating intracranial aneurysms. Since these landmark studies, development of new endovascular techniques, including balloon remodeling and stents, have enabled geometrically complex aneurysms to be treated with coil embolization. 2 , 17 , 21 , 23 , 27 , 35 The PulseRider (Pulsar Vascular) is a novel device intended for use in the treatment of wide-necked aneurysms arising at bifurcations. 44 It

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Visish M. Srinivasan, Aditya Srivatsan, Alejandro M. Spiotta, Benjamin K. Hendricks, Andrew F. Ducruet, Felipe C. Albuquerque, Ajit Puri, Matthew R. Amans, Steven W. Hetts, Daniel L. Cooke, Christopher S. Ogilvy, Ajith J. Thomas, Alejandro Enriquez-Marulanda, Ansaar Rai, SoHyun Boo, Andrew P. Carlson, R. Webster Crowley, Leonardo Rangel-Castilla, Giuseppe Lanzino, Peng Roc Chen, Orlando Diaz, Bradley N. Bohnstedt, Kyle P. O’Connor, Jan-Karl Burkhardt, Jeremiah N. Johnson, Stephen R. Chen and Peter Kan

T raditionally , stent-assisted coiling (SAC) and balloon remodeling have been the primary endovascular treatments for wide-necked intracranial aneurysms (IAs) with complex morphologies. PulseRider (Cerenovus) is a newly FDA-approved bifurcation IA device. It consists of a permanent nitinol (nickel titanium) self-expanding stent implant for the treatment of wide-necked aneurysms located at or near branching areas, specifically the internal carotid artery (ICA) and basilar terminus. The PulseRider device is either a Y- or T-shaped device, with limbs into the

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Visish M. Srinivasan, Aditya Vedantam and Peter Kan

We present a case of a patient with an anterior communicating artery aneurysm treated by PulseRider-assisted coil embolization. PulseRider is a new device, FDA approved for treatment of broad-necked aneurysms of the basilar apex or internal carotid artery terminus. The aneurysm was broad-necked and involved the anterior communicating artery and was considered for traditional stent-assisted coiling as well as PulseRider-assisted coiling. The authors present the treatment plan and strategy and then fluoroscopic recording of the PulseRider delivery and subsequent coiling phase. Nuances of technique for this new device used in a challenging setting are discussed.

The video can be found here: https://youtu.be/ont7ggqgLH8.

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John D. Nerva, Peter S. Amenta and Aaron S. Dumont

S rinivasan et al. 6 have presented a report of their early postmarket multicenter experience with the PulseRider device (Cerenovus) for wide-necked intracranial aneurysms in both on- and off-label cases (40 and 14 cases, respectively). The authors conducted a retrospective review of a prospective registry of 54 aneurysms treated at 13 centers. Aneurysms treated were not acutely ruptured, and patients were treated with dual antiplatelet therapy preoperatively. Technical success, defined as coil embolization of the aneurysm after PulseRider deployment, was

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Brian M. Corliss and Brian L. Hoh

I n this article, Mukherjee and colleagues describe their initial experience using the PulseRider (Pulsar Vascular), a novel intravascular stent, to treat 10 bifurcation aneurysms. 9 This study is only the second publication to include results of the device's application at bifurcation points other than the basilar tip or carotid terminus. The authors report excellent short-term results after 6 months of follow-up, with complete occlusion of all treated aneurysms and no significant complications. Since the advent of Gugliemi Detachable Coils in 1991

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direct carotid-cavernous fistula Chih-Hsiang Liao MD Wen-Hsien Chen MD Nien-Chen Liao MD Yuang-Seng Tsuei MD 01 2019 46 46 Suppl_1 Suppl_1 V11 V11 10.3171/2019.1.FocusVid.18447 2019.1.FocusVid.18447 PulseRider treatment of an anterior communicating artery aneurysm Visish M. Srinivasan MD Aditya Vedantam MD Peter Kan MD, MPH 01 2019 46 46 Suppl_1 Suppl_1 V12 V12 10.3171/2019.1.FocusVid.18425 2019.1.FocusVid.18425 Combined reconstructive and deconstructive endovascular approach for bilateral vertebral artery dissection with subarachnoid hemorrhage Jacob Cherian MD Thomas

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.3171/2016.6.JNS161361 2016.6.JNS161361 Transdural arterial recruitment to brain arteriovenous malformation: clinical and management implications in a prospective cohort series David Bervini 1, 2 MD, MAdvSurg Michael Kerin Morgan 2 MD Marcus Andrew Stoodley 2 PhD Gillian Ziona Heller 3 PhD 07 2017 02 09 2016 127 1 51 58 10.3171/2016.5.JNS16730 2016.5.JNS16730 Editorial. Initial experience with PulseRider treatment for wide-necked bifurcation aneurysms Brian M. Corliss MD Brian L. Hoh MD 07 2017 30 09 2016 127 1 59 60 10.3171/2016.3.JNS16412 2016.3.JNS16412 PulseRider

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Thomas R. Marotta, Howard A. Riina, Ian McDougall, Donald R. Ricci and Monika Killer-Oberpfalzer

S ixty-four percent of all cerebral aneurysms occur at arterial bifurcations. 3 To date, there are no commercially available stents and few endoluminal devices that are specifically designed to treat bifurcation aneurysms. Current options for the endovascular treatment of bifurcation aneurysms include 1) use of simple coiling (no stent) and balloon remodeling; 2) use of commercially available stents “off-label” to create a Y- or T-stent in conjunction with coils; 3) placement of coil-retaining devices in the parent artery (e.g., PulseRider [Pulsar Vascular

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Michael A. Silva, Alfred P. See, Hormuzdiyar H. Dasenbrock, Ramsey Ashour, Priyank Khandelwal, Nirav J. Patel, Kai U. Frerichs and Mohammad A. Aziz-Sultan

without using the stent deployment protocol, and there were no WEB devices placed without using it. FIG. 5. Plot of radiation as a function of fluoroscopic duration during aneurysm coiling from a 12-month period spanning the application of the stent deployment (SD) protocol. FL = fluoroscopy. Although not illustrated, the principles of improved image guidance demonstrated by the stent deployment protocol would be reasonably inferred to carry over to other devices under development and under trial at this time, such as PulseRider or Barrel vascular reconstruction device

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Benjamin K. Hendricks, James S. Yoon, Kurt Yaeger, Christopher P. Kellner, J Mocco, Reade A. De Leacy, Andrew F. Ducruet, Michael T. Lawton and Justin R. Mascitelli

further prospective study is necessary to determine the role of FD in WNA treatment. However, FD is not without complications, as shown by a recent systematic review that demonstrated an overall complication rate of 17%, with increased complications in patients with subarachnoid hemorrhage. 31 The most recent endovascular devices developed in the United States include the Woven EndoBridge (WEB) (Sequent Medical), which is an intrasaccular device, and novel aneurysm neck–support devices such as the PulseRider (Pulsar Vascular, Inc.). Additional devices with a less