Bifurcation Aneurysm Treatment with PulseRider: Technical Nuances, Device Selection, Positioning Strategies, and Overcoming Geometric Challenges

Background: 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 (PR), 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 PR applications to include design, general coil embolization technique, principles of deployment and detachment, positioning options, and geometric challenges and their solutions. Results: In our experience, the PR is well suited for addressing the challenges of treating bifurcation aneurysms. Conclusions: PR use is intuitive and straightforward for use in bifurcation aneurysms with ideal favorable. PR can also be safely and effectively used to address a much broader and more challenging range of geometries.