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Following the device’s limited market release in Europe towards the end of 2025, the CE-marked Avenir Pico coil system (WallabyPhenox) is now fully commercially available across the continent, providing neurointerventionists with a new and unique tool for the treatment of intracranial aneurysms. NeuroNews recently caught up with Pedro Vega (Hospital Universitario Central de Asturias, Oviedo, Spain)—an early adopter of Avenir Pico—to discuss his firsthand experiences with the device.
“The full market release of Avenir Pico expands the available toolkit for intracranial aneurysm coiling, particularly in cases that benefit from very soft, low-profile coils,” says Vega. “Having additional design options encourages tailored treatment strategies and may improve procedural confidence and versatility—especially in small or complex anatomies. Increased competition in the coiling market also tends to drive ongoing innovation, and refinement of techniques and devices, which ultimately benefits clinical practice.”
As of February 2026, Vega has used Avenir Pico in a handful of brain aneurysm cases and, despite this relatively small sample size, he has been able to identify multiple characteristics of the device that compare favourably to other coiling technologies.
“I started using Avenir Pico during its early clinical adoption phase and, overall, my initial experience has been very positive,” he relays. “The coil behaved predictably, was easy to control during deployment, and integrated smoothly into my usual coiling workflow, particularly in smaller and more delicate aneurysms.
“The coil’s design met my expectations. The softness was particularly noticeable, allowing good conformability to the aneurysm wall without exerting excessive force. The visibility under fluoroscopy was also adequate for precise positioning, and the detachment mechanism was reliable and intuitive with no unexpected delays or technical issues during deployment.”
In addition to reiterating how soft the coil was—and highlighting the clear benefits this brings in the treatment of fragile aneurysms—Vega states that its stability after detachment “stood out” as particularly positive.
“Compared to other low-profile coiling systems I have used, Avenir Pico is very competitive in terms of ease of use and controllability,” he adds. “It offers similar or improved softness while maintaining good framing stability, particularly as a finishing coil. Overall procedural outcomes were comparable or slightly improved in terms of packing control. The coil also had a positive impact on procedural efficiency by allowing smooth deployment and precise positioning, reducing the need for repositioning or coil exchanges. While long-term outcomes require further follow-up, the immediate angiographic results were satisfactory with good aneurysm occlusion and no device-related complications.”
Key considerations
Broadening the discussion to how he approaches intracranial aneurysm treatments in general, Vega brings up the “specific challenges” that hinge on location, size, morphology, and vascular anatomy, as well as other patient-related factors including dual antiplatelet therapy (DAPT) tolerance.
“From an endovascular perspective, location is crucial because it affects catheter access and stability,” he explains. “Aneurysms located in distal vessels, tortuous anatomies, or near critical perforators, can make navigation difficult and increase the risk of complications. Size and neck configuration are also key considerations, as wide-neck or large aneurysms often require advanced techniques such as stent-assisted coiling, balloon remodelling or flow diversion, which introduce additional complexity and require careful antiplatelet management.”
My advice to new users would be to take advantage of the coil’s softness by deploying slowly and deliberately, especially in the final coils.
Parent vessel diameter, branching patterns and vessel curvature all influence device selection and deployment accuracy, while aneurysms that are ruptured or have been treated previously create an additional level of complexity when it comes to treatments, and retreatments, respectively.
This convoluted and often challenging picture has not only led to the development of a range of different endovascular device types in aneurysm care, but also to the continuous evolution of embolisation coiling—which remains the most longstanding and commonly used modality in the space. According to Vega, the perpetual refinement of coil materials and designs represents a “major development”.
“Modern coils use softer, more conformable platinum alloys and complex three-dimensional shapes that improve packing density within the aneurysm sac,” he comments. “Higher packing densities have been associated with reduced rates of recurrence and retreatment. And, more recently, microcatheter and delivery system improvements—including better torque control, softer tips, and improved radiopacity—have enhanced navigation and placement accuracy in challenging anatomies, reducing procedural complications.”
The role for Avenir Pico
Returning to Avenir Pico—and how this innovation fits into the present landscape of neurointerventional care—Vega reaffirms that the device’s prevailing characteristics make it particularly well-suited to the management of smaller and more fragile aneurysms in which many traditional coils create an elevated procedural complication risk.
“I would recommend this coil to colleagues, particularly for small aneurysms, or during finishing stages where softness and control are essential,” Vega states. “My advice to new users would be to take advantage of the coil’s softness by deploying slowly and deliberately, especially in the final coils, and to select sizes carefully to optimise packing without overloading the aneurysm sac.”
When asked to identify any areas within which the Avenir Pico system in its current form could be optimised even further, Vega suggests that the introduction of additional length options or more intermediate sizes may provide physicians with an even greater level of flexibility in certain, very specific aneurysms. He is also quick to add, however, that the device’s presently available range of dimensions “did not limit its clinical use” in the cases he has performed to date.
“Given its high level of softness, the coil’s potential use could be expanded beyond aneurysm treatment to other neurovascular applications,” Vega concludes, offering a brief glimpse into what the future may hold for Avenir Pico. “In particular, it may be well-suited for the treatment of arteriovenous malformations [AVMs], especially when used as part of the ‘pressure-cooker’ technique where controlled, atraumatic coil deployment is essential to create a stable plug before liquid embolic injection.
“Additionally, the coil could provide value in the embolisation of chronic subdural haematomas [cSDHs]—a procedure that has been gaining significant adoption in recent years. In this setting, the ability to deploy very soft coils precisely within fragile distal branches can help achieve effective embolisation while minimising the risk of vessel injury or non-target embolisation.”
Regarding Avenir Pico’s primary area of focus as things stand, while it is hard to ignore the fact that newer introductions like flow-diverting stents and intrasaccular systems have joined embolisation coils as standard-of-care therapies in the endovascular management of brain aneurysms, Vega believes that coiling still has a considerable role to play—now, and moving forward.
“I have realised that, now, I am using fewer coils than I used to,” he adds. “But, I am still using them in many cases, and I think we are still very far from the end of coiling.”
