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Duan G, Zhang Y, Li Q, Yang P, Zhang J, Wang H, Ma J, Guan S, Han Z, Yang H, Shi H, Liu Y, Liang C, Wu X, Wu Y, Zuo Q, Feng Z, Zhang L, Li Z, Zhou Y, Dai D, Fang Y, Huang Q, Xu Y, Zhao R, Liu J. Gekko Coil System for Intracranial Aneurysms Treatment in China (GREAT-China): A Prospective Randomized Controlled Open-Label Noninferiority Trial. World Neurosurg 2024; 185:181-192. [PMID: 38286321 DOI: 10.1016/j.wneu.2024.01.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/21/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVE This study aimed to evaluate the safety and efficacy of the Gekko coil system in treating intracranial aneurysms (IAs) in clinical practice. METHODS A prospective multicenter randomized open-label parallel positive control noninferiority trial was conducted by 11 centers in China. Patients with a target IA were randomized 1:1 to coiling with either Gekko or Axium coils. The primary outcome was successful aneurysm occlusion at 6 months postoperative follow-up, whereas the secondary outcomes included the successful occlusion aneurysm rate in the immediate postoperative period, recanalization rate at the 6 months follow-up, and technical success and security. RESULTS Between May 2018 and September 2020, 256 patients were enrolled and randomized. Per-protocol analysis showed that the successful aneurysm occlusion rate at 6 months was 96.08% for the Gekko coil group compared with 96.12% in the Axium coil group, with a difference of -0.04% (P = 0.877). The successful immediate aneurysm occlusion rates were 86.00% and 77.45% in the Gekko coil group and the Axium coil group, respectively, showing no significant difference between the 2 groups (P = 0.116), whereas the recanalization rates during the 6 months follow-up were 2.02% and 1.96% in the Gekko and Axium coil groups, respectively, which was not statistically significant (P = 1.000). CONCLUSIONS This trial showed that the Gekko coil system was noninferior to the Axium coil system in terms of efficacy and safety for IA embolization. In clinical practice, the Gekko coil system can be considered safe and effective for treating patients with IA.
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Affiliation(s)
- Guoli Duan
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yuhang Zhang
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Qiang Li
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Pengfei Yang
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Jianmin Zhang
- Department of Neurosurgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Honglei Wang
- Department of Neurovascular Surgery, The First Affiliated Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Jun Ma
- Department of Neurovascular Center, Nanjing Brain Hospital affiliated to Nanjing Medical University, Nanjing City, Jiangsu province, China
| | - Sheng Guan
- Department of Interventional Neuroradiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Zhian Han
- Department of Cerebrovascular Intervention, Zhongshan People's Hospital, Zhongshan City, Guangdong Province, China
| | - Hua Yang
- Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province, China
| | - Haibin Shi
- Department of interventional radiology, Jiangsu Provincial Hospital, Jiangsu Province, China
| | - Yunhui Liu
- Department of Neurosurgery, Shengjing Hospital Affiliated to China Medical University, Shenyang City, Liaoning Province, China
| | - Chuansheng Liang
- Department of Neurosurgery, The First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | - Xin Wu
- Department of Neurosurgery, Yantai Yuhuangding hospital, Yantai City, Shandong Province, China
| | - Yina Wu
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Qiao Zuo
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Zhengzhe Feng
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Lei Zhang
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - ZiFu Li
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yu Zhou
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Dongwei Dai
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yibin Fang
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Qinghai Huang
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yi Xu
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Rui Zhao
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Jianmin Liu
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China.
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Cao R, Mattar A, Torche E, Riva R, Laubacher M, Moreno-Gomez R, Turjman F, Falini A, Panni P, Eker OF. Clinical and angiographic characteristics of ruptured and unruptured distal cerebral aneurysms: a review of a large series of cases in a high-volume center. J Neurointerv Surg 2024:jnis-2023-021164. [PMID: 38443187 DOI: 10.1136/jnis-2023-021164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/12/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To evaluate clinical, angiographic features, and endovascular approach of ruptured and unruptured distal intracranial aneurysms (DIAs). METHODS From January 2013 to February 2022, details of all consecutive intracranial aneurysms (IAs) treated endovascularly in our center were collected and retrospectively reviewed. IAs involving the anterior cerebral artery, middle cerebral artery, and posterior cerebral artery (distal to anterior communicating artery, limen insula, and P1 segment, respectively), and those distal to superior cerebellar artery, anterior-inferior cerebellar artery, and posterior inferior cerebellar artery's first segment were classified based on their etiology, location, size, and shape. Demographic, clinical, angiographic, and procedural variables, as well as follow-up outcomes were evaluated. RESULTS Of 2542 IAs, 151 (5.9%) DIAs were counted (average size 5.4±2.9 mm), including 61 (40.4%) unruptured and 90 (59.6%) ruptured. No difference in the aneurysmal size was observed, but aneurysms smaller than 4 mm were observed more frequently in the ruptured group (36.7% vs 18%; P=0.01). In addition, ruptured DIAs were more often non-saccular (40% vs 18%; P=0.004) and irregular (93.3% vs 59%; P<0.001), They were treated mostly by coiling, glue, and parent artery sacrifice (P=0.02, P=0.006, and P=0.001), whereas unruptured DIAs were treated by stent-assisted coiling and flow-diverter stents (P=0.001 and P<0.001, respectively), without any differences in occlusion (81.6% vs 82.5%) and recanalization (21.1% vs 17.5%) rates. Procedure-related complications occurred in 20/151 (13.2%) patients, without any differences between subgroups. Ruptured DIAs were more often re-treated (18.4% vs 5.3%, P=0.02). In multivariate analyses, irregular shape appeared as an independent predictor of ruptured presentation (OR=8.1, 95% CI 3.0 to 21.7; P<0.001). CONCLUSIONS Compared with unruptured DIAs, ruptured DIAs were more often non-saccular, irregular, and smaller than 4 mm. Despite different therapeutical approaches, ruptured and unruptured DIAs presented comparable occlusion and recanalization rates.
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Affiliation(s)
- Roberta Cao
- Hôpital Pierre Wertheimer, Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
- Department of Neuroradiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Adonis Mattar
- Hôpital Pierre Wertheimer, Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Esteban Torche
- Hôpital Pierre Wertheimer, Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Roberto Riva
- Hôpital Pierre Wertheimer, Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Morgane Laubacher
- Hôpital Pierre Wertheimer, Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Ricardo Moreno-Gomez
- Hôpital Pierre Wertheimer, Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Francis Turjman
- Hôpital Pierre Wertheimer, Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Andrea Falini
- Department of Neuroradiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Pietro Panni
- Department of Neuroradiology and Neurosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Omer F Eker
- Hôpital Pierre Wertheimer, Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
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Frandon J, Loffroy R, Marcelin C, Vernhet-Kovacsik H, Greffier J, Dabli D, Sammoud S, Marek P, Chevallier O, Beregi JP, Rousseau H. Safety and Efficacy of Prestige Coils for Embolization of Vascular Abnormalities: The Embo-Prestige Study. J Pers Med 2023; 13:1464. [PMID: 37888075 PMCID: PMC10608704 DOI: 10.3390/jpm13101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 10/28/2023] Open
Abstract
A wide variety of coils are available for vascular embolization. This study aimed to evaluate the safety and efficacy of a new Prestige coil. We carried out retrospective analysis of a multicenter's registry data collected between February 2022 and November 2022. The choice of embolization agent used to treat peripheral vascular anomalies was left to the investigator's discretion. Patients for whom at least one Prestige coil was used were included in Series 1. All other patients were included in Series 2. Efficacy and safety were evaluated. Patients were followed up for one month. In total, 220 patients were included, 110 in each series. Patients included 149 men (67.7%) and 71 women (32.3%), with a median age of 62.5 years (IQR: 35.8-73). Patient ages were similar in the two series. Complete occlusion of the targeted vessel was reported in 96.4% (n = 106/110) of patients in Series 1 and in 99.7% (n = 109/110) in Series 2. Four patients experienced non-serious adverse events (1.8%, n = 4/220): one experienced back pain and one vomiting in Series 1; one patient had off-target embolization and one a puncture site hematoma in Series 2. Sixteen patients (7.2%, n = 16/220) were lost to follow up. Improvement in the patient's general state at one month was reported in 79.0% (n = 83/105) of patients in Series 1 and in 74.7% (n = 74/99) in Series 2. Ten deaths occurred, five in Series 1 (4.8%, n = 5/105) and five in Series 2 (5.1%, n = 5/99). These deaths all concerned critically ill patients embolized for emergent arterial bleeding. In conclusion, the 1-month follow-up showed that Prestige coils, alone or in combination, are efficient and safe.
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Affiliation(s)
- Julien Frandon
- Department of Medical Imaging, IPI Plateform, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France; (J.G.); (D.D.); (S.S.); (J.-P.B.)
| | - Romaric Loffroy
- Department of Radiology, CHU Dijon-Bourgogne, 21079 Dijon, France; (R.L.); (O.C.)
| | - Clement Marcelin
- Centre Hospitalier Universitaire de Bordeaux, Service d’Imagerie Diagnostique et Thérapeutique de l’Adulte, Hopital Pellegrin, 33076 Bordeaux, France;
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, Université Bordeaux, 33076 Bordeaux, France
| | - Hélène Vernhet-Kovacsik
- Department of Radiology, CHU of Montpellier, Arnaud de Villeneuve Hospital, 34090 Montpellier, France;
| | - Joel Greffier
- Department of Medical Imaging, IPI Plateform, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France; (J.G.); (D.D.); (S.S.); (J.-P.B.)
| | - Djamel Dabli
- Department of Medical Imaging, IPI Plateform, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France; (J.G.); (D.D.); (S.S.); (J.-P.B.)
| | - Skander Sammoud
- Department of Medical Imaging, IPI Plateform, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France; (J.G.); (D.D.); (S.S.); (J.-P.B.)
| | - Pierre Marek
- Interventional Radiology Department, Rangueil Hospital, University Hospital of Toulouse, 31400 Toulouse, France; (P.M.); (H.R.)
| | - Olivier Chevallier
- Department of Radiology, CHU Dijon-Bourgogne, 21079 Dijon, France; (R.L.); (O.C.)
| | - Jean-Paul Beregi
- Department of Medical Imaging, IPI Plateform, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France; (J.G.); (D.D.); (S.S.); (J.-P.B.)
| | - Hervé Rousseau
- Interventional Radiology Department, Rangueil Hospital, University Hospital of Toulouse, 31400 Toulouse, France; (P.M.); (H.R.)
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4
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Volovici V, Verploegh IS, Satoer D, Vrancken Peeters NJMC, Sadigh Y, Vergouwen MDI, Schouten JW, Bruggeman G, Pisica D, Yildirim G, Cozar A, Muller F, Zidaru AM, Gori K, Tzourmpaki N, Schnell E, Thioub M, Kicielinski K, van Doormaal PJ, Velinov N, Boutarbouch M, Lawton MT, Lanzino G, Amin-Hanjani S, Dammers R, Meling TR. Outcomes Associated With Intracranial Aneurysm Treatments Reported as Safe, Effective, or Durable: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2331798. [PMID: 37656458 PMCID: PMC10474558 DOI: 10.1001/jamanetworkopen.2023.31798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
Importance Testing new medical devices or procedures in terms of safety, effectiveness, and durability should follow the strictest methodological rigor before implementation. Objectives To review and analyze studies investigating devices and procedures used in intracranial aneurysm (IA) treatment for methods and completeness of reporting and to compare the results of studies with positive, uncertain, and negative conclusions. Data Sources Embase, MEDLINE, Web of Science, and The Cochrane Central Register of Clinical Trials were searched for studies on IA treatment published between January 1, 1995, and the October 1, 2022. Grey literature was retrieved from Google Scholar. Study Selection All studies making any kind of claims of safety, effectiveness, or durability in the field of IA treatment were included. Data Extraction and Synthesis Using a predefined data dictionary and analysis plan, variables ranging from patient and aneurysm characteristics to the results of treatment were extracted, as were details pertaining to study methods and completeness of reporting. Extraction was performed by 10 independent reviewers. A blinded academic neuro-linguist without involvement in IA research evaluated the conclusion of each study as either positive, uncertain, or negative. The study followed Preferring Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Main Outcomes and Measures The incidence of domain-specific outcomes between studies with positive, uncertain, or negative conclusions regarding safety, effectiveness, or durability were compared. The number of studies that provided a definition of safety, effectiveness, or durability and the incidence of incomplete reporting of domain-specific outcomes were evaluated. Results Overall, 12 954 studies were screened, and 1356 studies were included, comprising a total of 410 993 treated patients. There was no difference in the proportion of patients with poor outcome or in-hospital mortality between studies claiming a technique was safe, uncertain, or not safe. Similarly, there was no difference in the proportion of IAs completely occluded at last follow-up between studies claiming a technique was effective, uncertain, or noneffective. Less than 2% of studies provided any definition of safety, effectiveness, or durability, and only 1 of the 1356 studies provided a threshold under which the technique would be considered unsafe. Incomplete reporting was found in 546 reports (40%). Conclusions and Relevance In this systematic review and meta-analysis of IA treatment literature, studies claiming safety, effectiveness, or durability of IA treatment had methodological flaws and incomplete reporting of relevant outcomes supporting these claims.
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Affiliation(s)
- Victor Volovici
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Iris S. Verploegh
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Djaina Satoer
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | | | - Yasmin Sadigh
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Mervyn D. I. Vergouwen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Joost W. Schouten
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Gavin Bruggeman
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Dana Pisica
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
- Centre for Medical Decision Science, Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Gizem Yildirim
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Ayca Cozar
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Femke Muller
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Ana-Maria Zidaru
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Kelsey Gori
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Nefeli Tzourmpaki
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Esther Schnell
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Mbaye Thioub
- Department of Neurosurgery, CHNU Fann, University Cheikh Anta Diop, Dakar, Senegal
| | | | - Pieter-Jan van Doormaal
- Department of Interventional Radiology, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Nikolay Velinov
- Department of Neurosurgery, University Hospital Pirogov, Medical University of Sofia, Sofia, Bulgaria
| | - Mahjouba Boutarbouch
- Department of Neurosurgery, Hopital des Specialites, University Mohammed V, Rabat, Morrocco
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Giuseppe Lanzino
- Department of Neurosurgery and Interventional Neuroradiology, Mayo Clinic, Rochester, Minnesota
| | | | - Ruben Dammers
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
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5
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Patra DP, Syal A, Rahme RJ, Abi-Aad KR, Singh R, Turcotte EL, Jones BA, Meyer J, Hudson M, Chong BW, Dabus G, James RF, Krishna C, Bendok BR. A comparison of treating physician versus independent core lab assessments of post-aneurysm treatment imaging outcomes: an analysis of prospectively collected data from a randomized trial. J Neurosurg 2023; 139:85-93. [PMID: 36681980 DOI: 10.3171/2022.10.jns22841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Aneurysm occlusion has been used as surrogate marker of aneurysm treatment efficacy. Aneurysm occlusion scales are used to evaluate the outcome of endovascular aneurysm treatment and to monitor recurrence. These scales, however, require subjective interpretation of imaging data, which can reduce the utility and reliability of these scales and the validity of clinical studies regarding aneurysm occlusion rates. Use of a core lab with independent blinded reviewers has been implemented to enhance the validity of occlusion rate assessments in clinical trials. The degree of agreement between core labs and treating physicians has not been well studied with prospectively collected data. METHODS In this study, the authors analyzed data from the Hydrogel Endovascular Aneurysm Treatment (HEAT) trial to assess the interrater agreement between the treating physician and the blinded core lab. The HEAT trial included 600 patients across 46 sites with intracranial aneurysms treated with coiling. The treating site and the core lab independently reviewed immediate postoperative and follow-up imaging (3-12 and 18-24 months, respectively) using the Raymond-Roy occlusion classification (RROC) scale, Meyer scale, and recanalization survey. A post hoc analysis was performed to calculate interrater reliability using Cohen's kappa. Further analysis was performed to assess whether degree of agreement varied on the basis of various factors, including scale used, timing of imaging, size of the aneurysm, imaging modality, location of the aneurysm, dome-to-neck ratio, and rupture status. RESULTS Minimal interrater agreement was noted between the core lab reviewers and the treating physicians for assessing aneurysm occlusion using the RROC grading scale (k = 0.39, 95% CI 0.38-0.40) and Meyer scale (k = 0.23, 95% CI 0.14-0.38). The degree of agreement between groups was slightly better but still weak for assessing recanalization (k = 0.45, 95% CI 0.38-0.52). Factors that significantly improved degree of agreement were scales with fewer variables, greater time to follow-up, imaging modality (digital subtraction angiography), and wide-neck aneurysms. CONCLUSIONS Assessment of aneurysm treatment outcome with commonly used aneurysm occlusion scales suffers from risk of poor interrater agreement. This supports the use of independent core labs for validation of outcome data to minimize reporting bias. Use of outcome tools with fewer point categories is likely to provide better interrater reliability. Therefore, the outcome assessment tools are ideal for clinical outcome assessment provided that they are sensitive enough to detect a clinically significant change.
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Affiliation(s)
- Devi P Patra
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix
- 2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix
- 3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Arjun Syal
- 4New York Medical College, Valhalla, New York
| | - Rudy J Rahme
- 5Department of Neurosurgery, Global Neuroscience Institute, Philadelphia, Pennsylvania
| | | | - Rohin Singh
- 7Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Evelyn L Turcotte
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix
- 2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix
- 3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Breck A Jones
- 3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
- 8Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Jenna Meyer
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix
- 2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix
- 3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Miles Hudson
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix
- 2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix
- 3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Brian W Chong
- 12Department of Radiology, Mayo Clinic, Phoenix, Arizona
| | - Guilherme Dabus
- 9Department of Neuroradiology, Miami Neuroscience Institute, Baptist Health South Florida, Miami, Florida
| | - Robert F James
- 10Department of Neurosurgery, IU Health Physicians Neurosurgery, Indianapolis, Indiana
| | - Chandan Krishna
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix
- 2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix
- 3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Bernard R Bendok
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix
- 2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix
- 3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
- 11Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix
- 12Department of Radiology, Mayo Clinic, Phoenix, Arizona
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6
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Tessitore A, Paolucci A, Hohenstatt S, Caragliano AA, Buonomo O, Mormina E, Pitrone A, Vinci SL. Comparison between second generation HydroSoft coils and bare platinum coils for the treatment of large intracranial aneurysms. Interv Neuroradiol 2022:15910199221088711. [PMID: 35317639 PMCID: PMC10369119 DOI: 10.1177/15910199221088711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The development of HydroSoft coils (HSC) aims to reduce the high recurrence and retreatment rates observed in large brain aneurysms by improving primary brain aneurysm filling and thus occlusion efficacy. We compared clinical and angiographic effectiveness of bare platinum coils (BPC) versus second generation HSC for large intracranial aneurysms at our center. METHODS We included 61 large aneurysms between 2015 and 2018, 29 embolized primarily using HSC and 32 treated with BPC. The aneurysm occlusion rates were assessed after 3 and 12 months with an MRI scan and at 6 moths with a control digital subtraction angiography (DSA) using the Raymond-Roy occlusion classification (RROC). Clinical outcomes were evaluated using the modified ranking scale (mRS). RESULTS The observed immediate occlusion rate was slightly better in the BPC group, however, this group had a significant increase of progressive reperfusion at all imaging follow-up. Contrarily, the rate of complete occlusion increased significantly in the HSC group, starting from the 6 and 12-months follow-up. 7 aneurysms (11.4%) were re-treated (15.6% BPC and 6.9% HSC). The 6 and 12-months clinical data showed mRS score 0-1 in 96.7% of patients. CONCLUSIONS In our single-center experience, the second generation HydroSoft coils were shown to be safe and effective for endovascular treatment of large intracranial aneurysms with encouraging clinical and angiographic results, also for ruptured aneurysms. Even if the validity is limited due to our small cohort size, HSC showed a significantly lower rate of recurrence at mid-term follow-up when compared to BPC.
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Affiliation(s)
- Agostino Tessitore
- Neuroradiology Unit, University Hospital A.O.U. Policlinico "G. Martino" - Messina, Italy
| | - Aldo Paolucci
- Operative Unit of Neuroradiology, 9339Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Sophia Hohenstatt
- Department of Neuroradiology, 27178Heidelberg University Hospital, Heidelberg, Germany
| | - Antonio A Caragliano
- Neuroradiology Unit, University Hospital A.O.U. Policlinico "G. Martino" - Messina, Italy
| | - Orazio Buonomo
- Neuroradiology Unit, University Hospital A.O.U. Policlinico "G. Martino" - Messina, Italy
| | - Enricomaria Mormina
- Neuroradiology Unit, University Hospital A.O.U. Policlinico "G. Martino" - Messina, Italy
| | - Antonio Pitrone
- Neuroradiology Unit, University Hospital A.O.U. Policlinico "G. Martino" - Messina, Italy
| | - Sergio L Vinci
- Neuroradiology Unit, University Hospital A.O.U. "G. Martino" Messina, Italy.,Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, 18980University of Messina, Italy
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7
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Clinical outcomes of first- and second-generation hydrogel coils compared with bare platinum coils: a systematic literature review. Neurosurg Rev 2022; 45:1873-1882. [PMID: 35031898 DOI: 10.1007/s10143-021-01632-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 05/19/2021] [Accepted: 06/19/2021] [Indexed: 10/19/2022]
Abstract
Endovascular coiling has revolutionized intracranial aneurysm treatment; however, recurrence continues to represent a major limitation. The hydrogel coil was developed to increase packing density and improve neck healing and therefore decrease recurrence rates. In this paper, we review treatment outcomes of first- (1HCs) and second-generation (2HCs) hydrogel coils and compare them to those of bare platinum coils (BPC). A query of multiple databases was performed. Articles with at least 10 aneurysms treated with either 1HC or 2HC were selected for analysis. Collected data included aneurysm size, rupture status, initial occlusion, initial residual neck/aneurysm, packing density, mortality, morbidity, recurrence, and retreatment rates. The primary endpoint was recurrence at final follow-up. Secondary endpoints included residual neck and dome rates as well as procedure-related complications and functional dependence at final follow-up. Studies that compared 1HC to BPC showed significant lower recurrence (24% vs. 30.8%, p = 0.02) and higher packing density (58.5% vs. 24.1%, p < 0.001) in 1HC but no significant difference in initial occlusion rate (p = 0.08). Studies that compared 2HC to BPC showed lower recurrence (6.3% vs. 14.3%, p = 0.007) and retreatment rates (3.4% vs. 7.7%, p = 0.010) as well as higher packing density (36.4% vs. 29.2%, p = 0.002) in 2HC, with similar initial occlusion rate (p = 0.86). The rate of complications was not statistically different between HC (25.5%) and BPC (22.6%, p = 0.06). Based on our review, the 1HC and 2HC achieved higher packing density and lower recurrence rates compared to BPC. The safety profile was similar between both groups.
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8
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Paul A, MacDonell J, Field N, Entezami P, Yamamoto J, Boulos A, Dalfino J. Comparison of hydrogel coils versus bare platinum coils for the treatment of anterior communicating artery aneurysms. Brain Circ 2022; 8:6-9. [PMID: 35372730 PMCID: PMC8973442 DOI: 10.4103/bc.bc_18_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/21/2021] [Accepted: 10/06/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION: METHODS: RESULTS: CONCLUSIONS:
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9
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Zhao R, Duan G, Yang P, Li T, Guan S, Yang H, Zhao Z, Zhu X, Liang G, Wu X, Leng B, Wang Y, Wu Y, Zuo Q, Zhang L, Li Z, Zhou Y, Zhao K, Dai D, Fang Y, Li Q, Huang Q, Hong B, Xu Y, Liu J. Endovascular aneurysm treatment with the Numen coil embolization system: A prospective, randomized, controlled, open-label, multi-center, non-inferiority trial in China. World Neurosurg 2021; 160:e23-e32. [PMID: 34906756 DOI: 10.1016/j.wneu.2021.11.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES We investigated the safety and efficacy of the Numen coil in comparison to the Axium coil in the treatment of intracranial aneurysms. METHODS As CATCH is a prospective, randomized, controlled, open-label, non-inferiority trial conducted in ten centers across China, subjects who fulfilled the inclusion and exclusion criteria were randomized 1:1 to either a test group (Numen) or a control group (Axium). The primary outcome was based upon the successful aneurysm occlusion at the six-month follow-up, while secondary outcomes included technical success, the recanalization and retreatment rates, the rate of serious adverse events (SAE) at the six-month and 12-month follow-up. RESULTS Between August 2017-December 2019, a total of 350 subjects presenting with 350 aneurysms were enrolled and randomized. Per-protocol analysis revealed that the successful aneurysm occlusion rate at six months was 91.18% for the test group as compared to 91.85% in the control group, with a difference of -0.68% (p = 0.8419), while the overall mortality rates during the 30-day follow-up period were 1.19% and 1.81% in the test and control group, respectively showing no significant difference between the two groups (p = 0.6837) whereas the SAEs incidence during the 12-month follow-up period was 12.50% and 17.47% in the test and control group, respectively which was not statistically significant (p = 0.2222). CONCLUSION This trial demonstrated that the Numen coil was non-inferior to the Axium coil in terms of intracranial aneurysm embolization and can be considered as a safe and effective coils for treating intracranial aneurysm patients in clinical practice.
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Affiliation(s)
- Rui Zhao
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Guoli Duan
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Pengfei Yang
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Tianxiao Li
- Department of Interventional radiology, Henan Provincial People's hospita, Weiwu Road 7#, Zhengzhou municipality, Henan Province
| | - Sheng Guan
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou Universit, Longhu middle ring road 1#, Jinshui District, Zhengzhou City, Henan Province
| | - Hua Yang
- Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyi street 28#, Yunyan District, Guiyang City, Guizhou Province
| | - Zhenwei Zhao
- Department of Neurosurgery, Tangdu Hospital Affiliated to Fourth Military Medical University, Xinsi Road 1#, Baqiao District, Xi'an City, Shaanxi Province
| | - Xingen Zhu
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Minde Road 1#, Nanchang City, Jiangxi Province
| | - Guobiao Liang
- Department of Neurosurgery, The General Hospital of Shenyang military, Wenhua Road 83#, Shenhe district,Shenyang Province (Guobiao Liang)
| | - Xin Wu
- Department of Neurosurgery, Yantai Yuhuangding hospital, Yuhuangding East Road 20#, Zhifu District, Yantai City, Shandong Province
| | - Bing Leng
- Department of Neurosurgery, Huashan hospital, Middle Wulumuqi Road 12#, Shanghai, China(Bing Leng)
| | - Yang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Yongwai Main Street 12#, Nanchang City, Jiangxi Province
| | - Yina Wu
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Qiao Zuo
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Lei Zhang
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - ZiFu Li
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Yu Zhou
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Kaijun Zhao
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Dongwei Dai
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Yibin Fang
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Qiang Li
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Qinghai Huang
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Bo Hong
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Yi Xu
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China;.
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Delayed middle cerebral artery occlusion following endovascular coiling of carotid terminus aneurysm. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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11
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Spiotta AM, Park MS, Bellon RJ, Bohnstedt BN, Schirmer CM, De Leacy RA, Fiorella DJ, Yoo AJ, Dumont TM, Starke RM. Technical Success and Early Efficacy in 851 Patients with Saccular Intracranial Aneurysms: A Subset Analysis of SMART, a Prospective, Multicenter Registry Assessing the Embolization of Neurovascular Lesions using the Penumbra SMART COIL System. World Neurosurg 2021; 155:e323-e334. [PMID: 34419663 DOI: 10.1016/j.wneu.2021.08.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The Prospective, Multicenter Registry Assessing the Embolization of Neurovascular Lesions Using the Penumbra SMART COIL® System (SMART) is the largest prospective, multicenter, postmarket registry established to gather real-world experience on Penumbra (Alameda, USA) SMART COIL System, PC400, and POD embolization coils. The goal of this study is to report the technical success and efficacy of SMART COIL System coils in treating saccular intracranial aneurysms. METHODS This subgroup analysis from the SMART registry included patients with saccular intracranial aneurysms treated using ≥75% SMART COIL System or PC400 coils. Baseline and procedural data, angiographic data, and clinical outcomes were collected. Predictors of catheter kickout, packing density, and postprocedural angiographic outcome were analyzed using multivariable regression models in saccular aneurysm cases. RESULTS Between June 2016 and August 2018, the SMART registry enrolled 995 patients at 68 sites, of which 851 of 995 (85.5%) were treated for saccular aneurysms (mean age, 59.9 years). Aneurysms had a mean size of 6.8 mm, were wide neck in 63.1%, and ruptured in 31.0% of patients. Mean aneurysm packing density was 32.3%. Postprocedural Raymond-Roy Occlusion Classification (RROC) I-II was achieved in 80.3% of patients; smaller aneurysms, non-wide-neck aneurysms, and high packing density were predictive of RROC I-II. Overall, mean fluoroscopic time was 43.4 minutes, rate of reaccess attempts because of catheter kickout was 6.2%, and mean procedure time was 83.2 minutes. CONCLUSIONS SMART COIL System coils achieved good technical success and adequate occlusion in treating saccular intracranial aneurysms in a real-world setting.
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Affiliation(s)
- Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
| | - Min S Park
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Richard J Bellon
- Radiology Imaging Associates Neurovascular Clinic, Englewood, Colorado, USA
| | | | - Clemens M Schirmer
- Department of Neurosurgery and Neuroscience Institute, Geisinger and Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA; Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Reade A De Leacy
- Departments of Neurosurgery & Radiology, Mount Sinai Health System, New York, New York, USA
| | - David J Fiorella
- Department of Neurosurgery, Stony Brook University Medical Center, Cerebrovascular Center, New York, USA
| | - Albert J Yoo
- Interventional Neuroradiology, Texas Stroke Institute, Dallas-Fort Worth, Texas, USA
| | - Travis M Dumont
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami Hospital, Miami, Florida, USA
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Bae HJ, Park YK, Cho DY, Choi JH, Kim BS, Shin YS. Predictors of the Effects of Flow Diversion in Very Large and Giant Aneurysms. AJNR Am J Neuroradiol 2021; 42:1099-1103. [PMID: 33926897 PMCID: PMC8191680 DOI: 10.3174/ajnr.a7085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/24/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The treatment paradigm for very large and giant aneurysms has recently changed to flow diversion, in light of the results of the Pipeline for Uncoilable or Failed Aneurysms trial. However, the effects of flow diversion were definitely unknown. We explored this topic and identified the predictors of such effects. MATERIALS AND METHODS We retrospectively reviewed 51 patients with unruptured aneurysms admitted to our institution for flow diversion between February 2014 and August 2019. Patients were categorized into an effect group (no filling or remnant entry) and a no-effect group (subtotal or total filling). We evaluated the aneurysm size and shape, incorporation vessel, parent artery stenosis and curvature, stagnation of contrast medium within the aneurysm, use of balloon angioplasty, and intra-aneurysm thrombus as potential predictors of the effects of flow diversion. RESULTS The effect group comprised 34 patients (66.7%, 34/51; no filling, 35.3%, 18/51; and remnant entry, 31.4%, 16/51). The no-effect group comprised 17 patients (33.3%, 17/51; subtotal filling, 29.4%, 15/51; and total filling, 3.9%, 2/51). An incorporation vessel and balloon angioplasty were independent risk factors for the no-effect group in multivariate logistic regression analyses (OR = 0.13 and 0.05; 95% confidence intervals, 0.02-0.62 and 0.00-0.32; P values, .021 and .004, respectively). CONCLUSIONS Flow diversion is effective for very large and giant aneurysms, but the outcomes require further improvement. The results of this study show that an incorporated vessel and excessive balloon angioplasty might compromise flow diversion. This finding can help improve the outcomes of flow diversion.
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Affiliation(s)
- H J Bae
- From the Department of Neurosurgery (H.J.B.), Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Y K Park
- Department of Neurosurgery (Y.K.P.), Inje University Ilsan Paik Hospital, Goyang, Korea
| | - D Y Cho
- Department of Neurosurgery (D.Y.C.), Ewha Womans University, Seoul, Korea
| | - J H Choi
- Department of Neurosurgery (J.H.C., Y.S.S.), Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine. Seoul, Republic of Korea
| | - B S Kim
- Department of Radiology (B.S.K.), Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Y S Shin
- Department of Neurosurgery (J.H.C., Y.S.S.), Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine. Seoul, Republic of Korea
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13
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Spiotta AM, Park MS, Bellon RJ, Bohnstedt BN, Yoo AJ, Schirmer CM, DeLeacy RA, Fiorella DJ, Woodward BK, Hawk HE, Nanda A, Zaidat OO, Sunenshine PJ, Liu KC, Kabbani MR, Snyder KV, Sivapatham T, Dumont TM, Reeves AR, Starke RM. The SMART Registry: Long-Term Results on the Utility of the Penumbra SMART COIL System for Treatment of Intracranial Aneurysms and Other Malformations. Front Neurol 2021; 12:637551. [PMID: 33927680 PMCID: PMC8076606 DOI: 10.3389/fneur.2021.637551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/12/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Penumbra SMART COIL® (SMART) System is a novel generation embolic coil with varying stiffness. The study purpose was to report real-world usage of the SMART System in patients with intracranial aneurysms (ICA) and non-aneurysm vascular lesions. Materials and Methods: The SMART Registry is a post-market, prospective, multicenter registry requiring ≥75% Penumbra Coils, including SMART, PC400, and/or POD coils. The primary efficacy endpoint was retreatment rate at 1-year and the primary safety endpoint was the procedural device-related serious adverse event rate. Results: Between June 2016 and August 2018, 995 patients (mean age 59.6 years, 72.1% female) were enrolled at 68 sites in the U.S. and Canada. Target lesions were intracranial aneurysms in 91.0% of patients; 63.5% were wide-neck and 31.8% were ruptured. Adjunctive devices were used in 55.2% of patients. Mean packing density was 32.3%. Procedural device-related serious adverse events occurred in 2.6% of patients. The rate of immediate post-procedure adequate occlusion was 97.1% in aneurysms and the rate of complete occlusion was 85.2% in non-aneurysms. At 1-year, the retreatment rate was 6.8%, Raymond Roy Occlusion Classification (RROC) I or II was 90.0% for aneurysms, and Modified Rankin Scale (mRS) 0-2 was achieved in 83.1% of all patients. Predictors of 1-year for RROC III or retreatment (incomplete occlusion) were rupture status (P < 0.0001), balloon-assisted coiling (P = 0.0354), aneurysm size (P = 0.0071), and RROC III immediate post-procedure (P = 0.0086) in a model that also included bifurcation aneurysm (P = 0.7788). Predictors of aneurysm retreatment at 1-year was rupture status (P < 0.0001). Conclusions: Lesions treated with SMART System coils achieved low long-term retreatment rates. Clinical Trial Registration:https://www.clinicaltrials.gov/, identifier NCT02729740.
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Affiliation(s)
- Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, United States
| | - Min S Park
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States
| | - Richard J Bellon
- Department of Interventional Neuro Radiology, Swedish Medical Center, Denver, CO, United States
| | | | - Albert J Yoo
- Department of Interventional Neuroradiology, Texas Stroke Institute, Dallas, TX, United States
| | | | | | - David J Fiorella
- Stony Brook University Medical Center, Cerebrovascular Center, New York, NY, United States
| | | | - Harris E Hawk
- Erlanger Health System, Chattanooga, TN, United States
| | - Ashish Nanda
- SSM Health Medical Group, Fenton, MO, United States
| | - Osama O Zaidat
- St Vincent Mercy Health Medical Center, Toledo, OH, United States
| | | | - Kenneth C Liu
- Penn State Milton S. Hershey Medical Center, Hershey, PA, United States
| | | | - Kenneth V Snyder
- Department of Neurosurgery, University of Buffalo, Buffalo, NY, United States
| | | | - Travis M Dumont
- Department of Surgery, University of Arizona, Tucson, AZ, United States
| | - Alan R Reeves
- Department of Radiology, University of Kansas, Kansas City, KS, United States
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami Hospital, Miami, FL, United States
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14
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Long-Term Outcome of Endovascular Therapy for Large or Giant Thrombosed Intracranial Aneurysms. World Neurosurg 2020; 144:e507-e512. [PMID: 32891840 DOI: 10.1016/j.wneu.2020.08.213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Large or giant thrombosed intracranial aneurysms (LGTIAs) are highly associated with poor prognosis and remain a challenging disease to treat by either surgery or endovascular treatment (EVT). EVT is considered more difficult for complicated aneurysm like LGTIAs. To understand long-term clinical and angiographic outcomes of EVT for LGTIAs, we retrospectively analyzed our single-center data on multimodality EVT for patients with LGTIAs. METHODS From the data of 35 EVT procedures performed in 31 consecutive patients with LGTIAs at our institution between December 2004 and December 2018, the rate of periprocedural complications, clinical outcomes at 12 months after EVT, and the rate of aneurysm recurrence were analyzed, and their related factors were evaluated. RESULTS Initial EVTs were performed by deconstructive (n = 10) or reconstructive (n = 21) techniques. Although 5 patients (16%) died during the periprocedural period, 23 (74%) had good outcome at 12 months after the procedures. Among 26 patients with long-term follow-up, aneurysm recurrence was observed in 6 patients (23.1%; median time from treatment, 33.2 months). Aneurysm recurrence was significantly higher in patients with basilar artery aneurysm (P = 0.0421) and stroke (P = 0.0307); however, there was no significant difference between the procedures and devices used. CONCLUSIONS Multimodality EVT for LGTIAs was performed with similar clinical outcomes and better radiologic outcomes compared with previous reports. New innovative techniques and devices are expected to be helpful for long-term aneurysm occlusion.
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Campos JK, Cheaney Ii B, Lien BV, Zarrin DA, Vo CD, Colby GP, Lin LM, Coon AL. Advances in endovascular aneurysm management: flow modulation techniques with braided mesh devices. Stroke Vasc Neurol 2020; 5:1-13. [PMID: 32411402 PMCID: PMC7213520 DOI: 10.1136/svn-2020-000347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/28/2020] [Indexed: 02/07/2023] Open
Abstract
Flow diverters and flow disruption technology, alongside nuanced endovascular techniques, have ushered in a new era of treating cerebral aneurysms. Here, we provide an overview of the latest flow modulation devices and highlight their clinical applications and outcomes.
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Affiliation(s)
- Jessica K Campos
- Department of Neurosurgery, University of California Irvine School of Medicine, Orange, California, USA
| | - Barry Cheaney Ii
- Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - Brian V Lien
- Department of Neurosurgery, University of California Irvine School of Medicine, Orange, California, USA
| | - David A Zarrin
- Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chau D Vo
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Geoffrey P Colby
- UCLA Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Li-Mei Lin
- Carondelet Neurological Institute, St. Joseph's Hospital, Carondelet Health Network, Tucson, Arizona, United States
| | - Alexander L Coon
- Carondelet Neurological Institute, St. Joseph's Hospital, Carondelet Health Network, Tucson, Arizona, United States
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Kim MW, An S, Seok H, Jung H, Park DH, Yarin AL, Yoon SS. In vitro evaluation of Pt-coated electrospun nanofibers for endovascular coil embolization. Acta Biomater 2020; 101:285-292. [PMID: 31610340 DOI: 10.1016/j.actbio.2019.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/04/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
Abstract
Recently, endovascular coil embolization has been introduced to treat intracranial aneurysms because it has lower morbidity and mortality than surgical clipping. The endovascular coils prevent the extravasation of blood by decreasing the permeability of an aneurysm flow governed by Darcy's law. Here, we developed and explored Pt-coated micro-ropes for potential use as endovascular coils. Electrospinning with subsequent electroplating were employed to fabricate Pt-coated nanofibers, which were tightly twisted to form micro-ropes. The compatibility of Pt micro-ropes with commercial delivery catheters was verified and their performance was experimentally explored in an in vitro experimental model. The developed Pt-coated micro-ropes demonstrated feasibility as efficient and low-cost endovascular coils. STATEMENT OF SIGNIFICANCE: The use of Platinum (Pt)-coated polymer nanofibers to prevent blood extravasation has been demonstrated. These Pt nanofibers were installed within a microfluidic channel, and the resulting reduced permeability was evaluated using a fluid similar to blood. Based on the obtained results, these newly developed nanofibers are expected to decrease the operation cost for aneurysmal subarachnoid hemorrhage (SAH), owing their reduced size and low material cost. Overall, the use of this new material should reduce the operational risk associated with the multiple steps required to place the Pt coils at the SAH site. The compatibility of Pt micro-ropes with commercial delivery catheters was verified and their performance was experimentally explored in an in vitro experimental model. The developed Pt-coated micro-ropes demonstrated feasibility as efficient and low-cost endovascular coils.
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Histological and Transmission Electron Microscopy Results after Embolization with HydroSoft/HydroFrame Coils in Experimental Swine Aneurysm. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4834535. [PMID: 31886218 PMCID: PMC6915152 DOI: 10.1155/2019/4834535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 09/16/2019] [Accepted: 10/10/2019] [Indexed: 11/18/2022]
Abstract
Coiling and clipping are standard treatment strategies for cerebral aneurysms. Regardless of the strategy used, recanalization may affect the patient's prognosis. The aim of this study was to histologically and morphologically compare the tissue proliferation after coil embolization using bare platinum coils versus second-generation hydrogel coils (HydroSoft/HydroFrame; MicroVention, Inc., Aliso Viejo, CA, USA). Endothelial-like cell proliferation was seen in both groups at 2 weeks after surgery. Macroscopic findings showed a tighter layer at 4 weeks in the hydrogel coil group, and histological and immunohistochemical findings revealed endothelial cell proliferation. This layer became much thicker and tighter at 4 weeks after surgery. Aneurysms treated with second-generation hydrogel coils may be more stable and have a lower incidence of recanalization than those treated with bare platinum coils because of the tight endothelial layer proliferation.
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18
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Imamura H, Sakai N, Ito Y, Sakai C, Hyodo A, Miyachi S, Matsumaru Y, Yoshimura S, Abe T, Yamagami H, Hayakawa M, Sato H, Fujinaka T, Tanabe K. Prospective Registry of Embolization of Intracranial Aneurysms Using HydroSoft Coils: Results of the Japanese HydroSoft Registry. World Neurosurg 2019; 127:e631-e637. [PMID: 30947007 DOI: 10.1016/j.wneu.2019.03.234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The effect of HydroSoft coils on the prevention of recanalization and thrombosis after embolization is unclear. We herein report the results of the single-armed prospective Japanese HydroSoft Registry. METHODS Aneurysms with a diameter of <10 mm that were treated with a ≥50% length of HydroSoft coils were registered. We evaluated the safety and recanalization rate and analyzed the factors related to their recanalization and thrombosis 1 year later. RESULTS In total, 122 aneurysms were registered. Their mean maximum diameter and neck length were 6.4 and 3.9 mm, respectively. The mean length of the HydroSoft coils was 84.3%. No intracranial hemorrhage occurred, but 2 patients developed minor ischemic strokes. Angiographic examination immediately after the procedure showed complete obliteration, neck remnant (NR), and body filling (BF) in 20 (16.4%), 32 (26.2%), and 67 (54.9%) cases, respectively. One-year follow-up angiography showed complete obliteration, NR, and BF in 68 (55.7%), 15 (12.3%), and 15 (12.3%) cases, respectively, and 5 aneurysms (4.1%) were recanalized (4 and 1 with BF and NR as their initial angiographic result, respectively). Another 11 aneurysms still showed BF, although their thrombosis was promoted. No significant factors related to recanalization were identified. A high volume embolization ratio and small neck were significantly associated with thrombosis 1 year after embolization with HydroSoft coils. CONCLUSIONS The safety and prevention of recanalization 1 year after the treatment appeared acceptable. The high volume embolization ratio associated with HydroSoft coils could induce progression of thrombosis for aneurysms characterized by NR and BF during the follow-up period.
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Affiliation(s)
- Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Hyogo, Japan.
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Yasushi Ito
- Department of Neurosurgery, Shinrakuen Hospital, Niigata, Japan
| | - Chiaki Sakai
- Department of Neurosurgery, Hyogo College of Medicine Hospital, Hyogo, Japan
| | - Akio Hyodo
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Shigeru Miyachi
- Department of Neurological Surgery, Aichi Medical University, Aichi, Japan
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine Hospital, Hyogo, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Fukuoka, Japan
| | - Hiroshi Yamagami
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Mikito Hayakawa
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hiroaki Sato
- Department of Neuroendovascular Therapy, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Toshiyuki Fujinaka
- Department of Neurosurgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Kenichiro Tanabe
- Division of Medical Statistics, Translational Research Center for Medical Innovation, Hyogo, Japan
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Zhu Y, Zhang H, Zhang Y, Wu H, Wei L, Zhou G, Zhang Y, Deng L, Cheng Y, Li M, Santos HA, Cui W. Endovascular Metal Devices for the Treatment of Cerebrovascular Diseases. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2019; 31:e1805452. [PMID: 30589125 DOI: 10.1002/adma.201805452] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/20/2018] [Indexed: 06/09/2023]
Abstract
Cerebrovascular disease involves various medical disorders that obstruct brain blood vessels or deteriorate cerebral circulation, resulting in ischemic or hemorrhagic stroke. Nowadays, platinum coils with or without biological modification have become routine embolization devices to reduce the risk of cerebral aneurysm bleeding. Additionally, many intracranial stents, flow diverters, and stent retrievers have been invented with uniquely designed structures. To accelerate the translation of these devices into clinical usage, an in-depth understanding of the mechanical and material performance of these metal-based devices is critical. However, considering the more distal location and tortuous anatomic characteristics of cerebral arteries, present devices still risk failing to arrive at target lesions. Consequently, more flexible endovascular devices and novel designs are under urgent demand to overcome the deficiencies of existing devices. Herein, the pros and cons of the current structural designs are discussed when these devices are applied to the treatment of diseases ranging broadly from hemorrhages to ischemic strokes, in order to encourage further development of such kind of devices and investigation of their use in the clinic. Moreover, novel biodegradable materials and drug elution techniques, and the design, safety, and efficacy of personalized devices for further clinical applications in cerebral vasculature are discussed.
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Affiliation(s)
- Yueqi Zhu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Hongbo Zhang
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
- Department of Pharmaceutical Sciences Laboratory, Åbo Akademi University, Turku, FI-20520, Finland
- Turku Center for Biotechnology, University of Turku and Åbo Akademi University, Turku, FI-20520, Finland
| | - Yiran Zhang
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Huayin Wu
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
| | - Liming Wei
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Gen Zhou
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Yuezhou Zhang
- Department of Pharmaceutical Sciences Laboratory, Åbo Akademi University, Turku, FI-20520, Finland
- Turku Center for Biotechnology, University of Turku and Åbo Akademi University, Turku, FI-20520, Finland
| | - Lianfu Deng
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Yingsheng Cheng
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Minghua Li
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, P. R. China
| | - Hélder A Santos
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, FI-00014, Helsinki, Finland
- Helsinki Institute of Life Science, University of Helsinki, FI-00014, Helsinki, Finland
| | - Wenguo Cui
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
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20
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Taschner CA. Letter: A Randomized Trial of Second-Generation Hydrogel Neurovascular Coils. Neurosurgery 2019; 84:E96. [DOI: 10.1093/neuros/nyy463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Xue T, Chen Z, Lin W, Xu J, Shen X, Wang Z. Hydrogel coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms: a meta-analysis of randomized controlled trials. BMC Neurol 2018; 18:167. [PMID: 30290784 PMCID: PMC6172718 DOI: 10.1186/s12883-018-1171-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/28/2018] [Indexed: 11/30/2022] Open
Abstract
Background Recent studies have shown conflicting results regarding the effect of hydrogel coils for treating intracranial aneurysm compared to bare platinum coils. We implemented a meta-analysis to assess the value of hydrogel coils in intracranial aneurysm treatment. Methods The MEDLINE, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) which had evaluated hydrogel coils versus bare platinum coils for intracranial aneurysms. Results We pooled 1526 patients from 4 RCTs with the mean follow-up time of more than 16 months. Hydrogel coils had reductions on mid-term recurrence (RR 0.78, 95% CI 0.65 to 0.94, P = 0.008) and residual aneurysm (RR 0.71, 95% CI 0.57 to 0.88, P = 0.002), but didn’t show any significant differences in other favorable outcomes such as functional recovery, mortality and so on. In the subgroup analysis, we found that second-generation hydrogel coils might exhibit potential impacts on increasing mid-term complete occlusion (RR 1.26, 95% CI 1.07 to 1.48, P = 0.005) and decreasing residual aneurysm neck. (RR 0.54, 95% CI 0.34 to 0.86, P = 0.010). Conclusions Hydrogel coils showed no significant efficacy on functional recovery but exhibited a lower rate of recurrences and residual aneurysms in patients with intracranial aneurysms. Electronic supplementary material The online version of this article (10.1186/s12883-018-1171-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tao Xue
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China
| | - Zhouqing Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China
| | - Weiwei Lin
- University of Pittsburgh School of Pharmacy, Pittsburgh, PA, 15219, USA
| | - Jiayi Xu
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu Province, China
| | - Xuming Shen
- Department of Neurosurgery, Taicang Affiliated Hospital of Soochow University, Suzhou, 215400, Jiangsu Province, China.
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China.
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22
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Zussman B, Weiner G, Ducruet A. A Randomized Trial of Second-Generation Hydrogel Neurovascular Coils. Neurosurgery 2018; 83:E6-E7. [DOI: 10.1093/neuros/nyy169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Taschner CA, Chapot R, Costalat V, Machi P, Courthéoux P, Barreau X, Berge J, Pierot L, Kadziolka K, Jean B, Blanc R, Biondi A, Brunel H, Gallas S, Berlis A, Herbreteau D, Berkefeld J, Urbach H, Elsheikh S, Fiehler J, Desal H, Graf E, Bonafé A. Second-Generation Hydrogel Coils for the Endovascular Treatment of Intracranial Aneurysms: A Randomized Controlled Trial. Stroke 2018; 49:667-674. [PMID: 29437981 PMCID: PMC5839703 DOI: 10.1161/strokeaha.117.018707] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/29/2017] [Accepted: 12/07/2017] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— Endovascular embolization of intracranial aneurysms with hydrogel-coated coils lowers the risk of major recurrence, but technical limitations (coil stiffness and time restriction for placement) have prevented their wider clinical use. We aimed to assess the efficacy of softer, second-generation hydrogel coils. Methods— A randomized controlled trial was conducted at 22 centers in France and Germany. Patients aged 18 to 75 years with untreated ruptured or unruptured intracranial aneurysms measuring 4 to 12 mm in diameter were eligible and randomized (1:1 using a web-based system, stratified by rupture status) to coiling with either second-generation hydrogel coils or bare platinum coils. Assist devices were allowed as clinically required. Independent imaging core laboratory was masked to allocation. Primary end point was a composite outcome measure including major aneurysm recurrence, aneurysm retreatment, morbidity that prevented angiographic controls, and any death during treatment and follow-up. Data were analyzed as randomized. Results— Randomization began on October 15, 2009, and stopped on January 31, 2014, after 513 patients (hydrogel, n=256; bare platinum, n=257); 20 patients were excluded for missing informed consent and 9 for treatment-related criteria. Four hundred eighty-four patients (hydrogel, n=243; bare platinum, n=241) were included in the analysis; 208 (43%) were treated for ruptured aneurysms. Final end point data were available for 456 patients. Forty-five out of 226 (19.9%) patients in the hydrogel group and 66/230 (28.7%) in the control group had an unfavorable composite primary outcome, giving a statistically significant reduction in the proportion of an unfavorable composite primary outcome with hydrogel coils—adjusted for rupture status—of 8.4% (95% confidence interval, 0.5–16.2; P=0.036). Adverse and serious adverse events were evenly distributed between groups. Conclusions— Our results suggest that endovascular coil embolization with second-generation hydrogel coils may reduce the rate of unfavorable outcome events in patients with small- and medium-sized intracranial aneurysms. Clinical Trial Registration— URL: https://www.drks.de/drks_web/. Unique identifier: DRKS00003132.
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Affiliation(s)
- Christian A Taschner
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.).
| | - René Chapot
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Vincent Costalat
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Paolo Machi
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Patrick Courthéoux
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Xavier Barreau
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Jérôme Berge
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Laurent Pierot
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Krzysztof Kadziolka
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Betty Jean
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Raphaël Blanc
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Alessandra Biondi
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Hervé Brunel
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Sophie Gallas
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Ansgar Berlis
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Denis Herbreteau
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Joachim Berkefeld
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Horst Urbach
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Samer Elsheikh
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Jens Fiehler
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Hubert Desal
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Erika Graf
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Alain Bonafé
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
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Brinjikji W, Amar AP, Delgado Almandoz JE, Diaz O, Jabbour P, Hanel R, Hui F, Kelly M, Layton KD, Miller JW, Levy E, Moran C, Suh DC, Woo H, Sellar R, Ho B, Evans A, Kallmes DF. GEL THE NEC: a prospective registry evaluating the safety, ease of use, and efficacy of the HydroSoft coil as a finishing device. J Neurointerv Surg 2017; 10:83-87. [DOI: 10.1136/neurintsurg-2016-012915] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/05/2017] [Accepted: 01/10/2017] [Indexed: 11/03/2022]
Abstract
Background and purposeThe HydroSoft coil was developed as a finishing coil, ideally to be placed along the aneurysm neck to enhance intracranial aneurysm healing. The GEL THE NEC (Gaining Efficacy Long Term: Hydrosoft, an Emerging, New, Embolic Coil) multicenter registry was developed to assess the safety and efficacy of HydroSoft coils in treating intracranial aneurysms. We report angiographic and clinical results of this prospective registry.Materials and methodsGEL THE NEC was performed at 27 centers in five countries. Patients aged 21–90 years with a ruptured or unruptured aneurysm 3–15 mm in size were eligible for enrollment. The following variables were obtained: demographics/comorbidities, aneurysm geometry, adjunctive devices used, proportion of patients in whom HydroSoft coils were successfully placed, and long-term angiographic outcomes (graded by an independent core laboratory using the Modified Raymond Scale), and procedure-related adverse events. Predictors of good angiographic outcome were studied using χ2 and t-tests.ResultsA total of 599 patients with 599 aneurysms were included in this study. HydroSoft coils were successfully deployed in 577 (96.4%) patients. Procedure-related major morbidity and mortality were 0.5% (3/599) and 1.3% (8/599), respectively. The most common perioperative complications were iatrogenic vasospasm (30/599, 5.0%), thromboemboli (27/599, 4.5%), and aneurysm perforation (16/599, 2.7%). At last angiographic follow-up (mean 9.0±6.3 months), the complete occlusion rate was 63.2% (280/442) and near complete occlusion rate was 25.2% (107/442). The core laboratory read recanalization rate was 10.8% (46/425) and the retreatment rate was 3.4% (20/599).ConclusionsEndovascular treatment of intracranial aneurysms with HydroSoft coils resulted in complete/near complete occlusion rates of 88% and a major complication rate of 1.8%.Trial registration numberNCT01000675.
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Arihara M, Miyata K, Iihoshi S, Yamaguchi H, Toyama K, Komatsu K, Hashimoto A, Wanibuchi M, Mikuni N. Endovascular Therapy for a Post-irradiated Cervical Pseudoaneurysm at the Carotid Stump: A Case Report. NMC Case Rep J 2017; 4:59-62. [PMID: 28664029 PMCID: PMC5453302 DOI: 10.2176/nmccrj.cr.2016-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/01/2016] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Kei Miyata
- Department of Neurosurgery, Sapporo Medical University
- Department of Emergency Medicine, Sapporo Medical University
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Padma VM, Bhatia R, Kuruttukulam G, Alurkar A, Talwar KK, Khurana D, Kaul S, Suri V, Singh G, Huded V. A call for neurologists to take up stroke intervention. Ann Indian Acad Neurol 2016; 19:429-432. [PMID: 27994348 PMCID: PMC5144460 DOI: 10.4103/0972-2327.194408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Recent data have provided overwhelming evidence in favor of benefits of emergent endovascular intervention in large vessel acute ischemic stroke (AIS). India with its large population has a huge burden of AIS. Hence, neurologists need to gear up to the new challenge of providing interventional care to huge populations of AIS in the country. The best way to cover this unprecedented unmet need is to encourage neurologists to take up interventional subspecialty interests through new but sound training pathways.
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Affiliation(s)
- Vasantha M Padma
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anand Alurkar
- Department of Neurology, KEM Hospital, Pune, Maharashtra, India
| | | | - Dheeraj Khurana
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Kaul
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Vinit Suri
- Department of Neurology, Apollo Hospital, New Delhi, India
| | - Gagandeep Singh
- Department of Neurology, Dayanand Medical College, Ludhiana, Punjab, India
| | - Vikram Huded
- NH institute of Neurosciences, Bangalore, Karnataka, India
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Jiang B, Paff M, Colby GP, Coon AL, Lin LM. Cerebral aneurysm treatment: modern neurovascular techniques. Stroke Vasc Neurol 2016; 1:93-100. [PMID: 28959469 PMCID: PMC5435202 DOI: 10.1136/svn-2016-000027] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 07/26/2016] [Accepted: 07/28/2016] [Indexed: 11/18/2022] Open
Abstract
Endovascular treatment of cerebral aneurysm continues to evolve with the development of new technologies. This review provides an overview of the recent major innovations in the neurointerventional space in recent years.
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Affiliation(s)
- Bowen Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Michelle Paff
- Department of Neurosurgery, University of California, Irvine School of Medicine, UC Irvine Medical Center, Orange, California, USA
| | - Geoffrey P Colby
- Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Alexander L Coon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Li-Mei Lin
- Department of Neurosurgery, University of California, Irvine School of Medicine, UC Irvine Medical Center, Orange, California, USA
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Dabus G, Hacein-Bey L, Varjavand B, Tomalty RD, Han PP, Yerokhin V, Linfante I, Mocco J, Oxley T, Spiotta A, Chaudry MI, Turner RD, Turk AS. Safety, immediate and mid-term results of the newer generation of hydrogel coils in the treatment of ruptured aneurysms: a multicenter study. J Neurointerv Surg 2016; 9:419-424. [PMID: 27798856 DOI: 10.1136/neurintsurg-2016-012780] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the 'real-world' performance of the newer generation of hydrogel coils in ruptured aneurysms. METHODS A multicenter retrospective study was carried out of angiographic and clinical outcome data on consecutive patients with ruptured aneurysms treated with at least 70% of the newer generation of hydrogel coils. Demographics and data on clinical grade, smoking, use of statins, aneurysm size, location, technique used, packing density, immediate angiographic result, angiographic follow-up, rebleeding and clinical outcome were obtained and analyzed. RESULTS Eighty patients (54F; 26M) with an average age of 55.1 years were entered in the study. Forty-four presented good clinical grade (Hunt and Hess 1 or 2). Forty-two (52.5%) aneurysms were ≤5 mm. 56.7% of the aneurysms were treated with simple coil embolization and 39.6% with balloon-assisted coil. The packing density ranged from 9.3% to 92.6% (mean 48.5%). Immediate occlusion rates (Raymond-Roy Scale) were: complete occlusion (class I) in 57.5%, residual neck (class II) in 32.5% and residual aneurysm (class III) in 10%. Intraoperative rupture occurred in 3 cases (3.75%). Clinical follow-up, available in 73 patients, showed a good outcome (modified Rankin Scale 0-2) in 76.3%. Preliminary data on imaging follow-up were available in 54 patients (average 6.8 months) with complete occlusion in 77.8%, residual neck in 20.3% and residual aneurysm in 1.9%. There was no re-hemorrhage. CONCLUSIONS Our data show that the use of the newer-generation hydrogel coils in the treatment of ruptured aneurysms is feasible, safe and effective with high immediate and mid-term occlusion rates and low morbidity.
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Affiliation(s)
- Guilherme Dabus
- Miami Cardiac & Vascular Institute and Baptist Neuroscience Center, Miami, Florida, USA
| | | | | | | | - Patrick P Han
- St John Neuroscience Institute, Tulsa, Oklahoma, USA
| | | | - Italo Linfante
- Miami Cardiac & Vascular Institute and Baptist Neuroscience Center, Miami, Florida, USA
| | - J Mocco
- Mount Sinai Hospital, New York, New York, USA
| | | | - Alejandro Spiotta
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - M Imran Chaudry
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Raymond D Turner
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Aquilla S Turk
- Medical University of South Carolina, Charleston, South Carolina, USA
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