Bifurcation aneurysm treatment with PulseRider: Technical nuances, device selection, positioning strategies and overcoming geometrical challenges.

Abstract Background and Objective Endovascular therapy is a viable alternative to surgical clipping for the treatment of intracranial aneurysms, however, aneurysms arising at bifurcations remain a challenge. The purpose of this technical report is to share the nuances of treating aneurysms with the PulseRider, including device selection and positioning strategy, from authors who are highly experienced in its use. Methods We offer a comprehensive guide for neuroendovascular surgeons less experienced with PulseRider applications, to include design, general coil embolization technique, principles of deployment and detachment, positioning options, and geometrical challenges and their solutions. Results In our experience, the PulseRider is very well suited for addressing the challenges of treating bifurcation aneurysms. Conclusions PulseRider use is intuitive and straightforward for use in bifurcation aneurysms with ideal favorable. PulseRider can also be safely and effectively utilized to address a much broader and more challenging range of geometries.