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Zaidat OO, Castonguay AC, Rai AT, Badruddin A, Mack WJ, Alshekhlee AK, Shah QA, Hussain SI, Kabbani MR, Bulsara KR, Taqi AM, Janardhan V, Patterson MS, Nordhaus BL, Elijovich L, Puri AS. TARGET® Intracranial Aneurysm Coiling Prospective Multicenter Registry: Final Analysis of Peri-Procedural and Long-Term Safety and Efficacy Results. Front Neurol 2019; 10:737. [PMID: 31338061 PMCID: PMC6629893 DOI: 10.3389/fneur.2019.00737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/24/2019] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose: To describe the final results of the TARGET Registry, a multicenter, real-world study of patients with intracranial aneurysms treated with new generation TARGET Coils. Methods: The TARGET Registry is a prospective, single-arm study with independent medical event monitoring and core-lab adjudication. Patients with de novo intracranial aneurysms were embolized with either TARGET-360° or helical coils in 12 US centers. The primary outcome was aneurysm packing density (PD), which was assessed immediately post-procedure. The secondary outcomes were immediate and long-term aneurysm occlusion rate using the Raymond Scale, and independent functional outcome using the modified Rankin Scale (mRS). A secondary analysis investigated the influence of the use of 100% 360-complex coils on clinical and angiographic outcomes. Results: 148 patients with 157 aneurysms met the inclusion and exclusion criteria. 58 (39.2%) patients with ruptured and 90 (61.8%) with unruptured aneurysms were treated using TARGET 360°, helical Coils, or both. Median age was 58.3 (IQR 48.1–67.4), 73% female, and 71.6% were Caucasian. Median follow-up time was 5.9 (IQR 4.0–6.9) months. The majority were treated with TARGET 360-coils (63.7%), followed by mixed and helical coils only. Peri-procedural morbidity and mortality was seen in 2.7% of patients. A good outcome at discharge (mRS 0–2) was seen in 89.9% of the full cohort, and in 84.5 and 93.3% in the ruptured and unruptured patients, respectively. The median packing density was 28.8% (IQR 20.3–41.1). Long-term complete and near complete occlusion rate was seen in 90.4% of aneurysms and complete obliteration was seen in 66.2% of the aneurysms. No significant difference in clinical and angiographic outcomes were noted between the pure 360-complex coiling vs. mixed 360-complex/Helical coiling strategies. In a multivariate analysis, predictors for long-term aneurysm occlusion were aneurysm location, immediate occlusion grade, and aneurysm size. The long-term independent functional outcome was achieved in 128/135 (94.8%) patients and all-cause mortality was seen in 3/148 (2%) patients. Conclusion: In the multicenter TARGET Registry, two-thirds of aneurysms achieved long-term complete occlusion and 91.0% achieved complete or near complete occlusion with excellent independent functional outcome. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT01748903
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Affiliation(s)
- Osama O Zaidat
- Neuroscience Institute, Bon Secours Mercy Health St. Vincent Hospital, Toledo, OH, United States
| | | | - Ansaar T Rai
- Departments of Radiology, Neurology, and Neurosurgery, West Virginia University, Morgantown, WV, United States
| | - Aamir Badruddin
- Neuroscience Department, Presence St. Joseph Medical Center, Joliet, IL, United States
| | - William J Mack
- Department of Neurosurgery, University of Southern California, Los Angeles, CA, United States
| | - Amer K Alshekhlee
- SSM Neuroscience Institutes, DePaul Health, St. Louis, MO, United States
| | - Qaisar A Shah
- Abington Memorial Hospital, Abington, PA, United States
| | - Syed I Hussain
- Department of Neurology, Cleveland Clinic-Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Ketan R Bulsara
- Department of Neurosurgery, University of Connecticut, Farmington, CT, United States
| | - Asif M Taqi
- Desert Regional Medical Center, Palm Springs, CA, United States
| | | | - Mary S Patterson
- Neuroscience Institute, Bon Secours Mercy Health St. Vincent Hospital, Toledo, OH, United States
| | - Brittany L Nordhaus
- Neuroscience Institute, Bon Secours Mercy Health St. Vincent Hospital, Toledo, OH, United States
| | - Lucas Elijovich
- Vascular Anomalies Center, Le Bonheur Children's Hospital, Memphis, TN, United States
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts, Worcester, MA, United States
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Li K, Guo Y, Zhao Y, Xu B, Xu K, Yu J. Acute rerupture after coil embolization of ruptured intracranial saccular aneurysms: A literature review. Interv Neuroradiol 2017; 24:117-124. [PMID: 29231793 DOI: 10.1177/1591019917747245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Acute rerupture after coil embolization is defined as rerupture within three days after treatment; its prognosis is worse than that of rebleeding at other time periods. However, to date, little is known about complications during the acute phase. Therefore, we used the PubMed database to perform a review of acute rerupture after coil embolization of ruptured intracranial saccular aneurysms and increase our understanding. After reviewing the complications, we found that the cause of acute rerupture is unclear, but the following risk factors are involved: incomplete occlusion of the initial aneurysm, the presence of a hematoma adjacent to a ruptured aneurysm, an aneurysmal outpouching, poor Hunt-Hess grade at the time of treatment, and the location of the aneurysm in an anterior communicating artery. In addition, intraoperative rupture is a non-negligible cause. Acute rerupture after coil embolization mainly occurs within the first 24 hours after the procedure. Brain computed tomography is the gold standard for diagnosing acute rebleeding of a coiled aneurysm. For acute rerupture after coil embolization, prevention is critical, and complete occlusion of the aneurysm in the first session is the best protection against acute rebleeding. In addition, a restricted postembolization anticoagulation strategy is recommended for patients with high-risk aneurysms. For patients with an adjacent hematoma, surgical clipping is recommended. Most patients present no changes immediately after acute rebleeding because of their poor condition. However, surgical or endovascular treatments can be attempted if the patient is in an acceptable condition. Even so, the outcomes are typically unsatisfactory.
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Affiliation(s)
- Kailing Li
- 1 Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Yunbao Guo
- 1 Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Ying Zhao
- 2 Department of Training, The First Hospital of Jilin University, Changchun, China
| | - Baofeng Xu
- 1 Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Kan Xu
- 1 Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- 1 Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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