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Fuga M, Ishibashi T, Aoki K, Tachi R, Irie K, Kato N, Kan I, Hataoka S, Nagayama G, Sano T, Tanaka T, Murayama Y. Intermediate catheter use is associated with complete occlusion and dense packing in coil embolization of unruptured cerebral aneurysms: a propensity score matched study. J Neurointerv Surg 2024:jnis-2023-021258. [PMID: 38262727 DOI: 10.1136/jnis-2023-021258] [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: 11/15/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND An intermediate catheter (IMC) can improve the maneuverability and stability of the microcatheter. OBJECTIVE To investigate the efficacy and safety of using an IMC in triaxial systems for coil embolization of unruptured cerebral aneurysms (UCAs). METHODS A total of 2430 consecutive saccular UCAs (2259 patients) that underwent initial coil embolization at three institutions between November 2003 and May 2023 were retrospectively reviewed. Patients were classified into two groups: with IMC (IMC(+)) and without IMC (IMC(-)). To investigate whether IMC use increased the rate of complete occlusion and the packing density, a propensity score-matched analysis was used to control for clinical, anatomical, and procedural features. RESULTS Ultimately, 595 (24.5%) coil embolization used an IMC. Propensity score matching was successful for 424 paired IMC(+) and IMC(-) aneurysms. Compared with the IMC(-) group, the IMC(+) group had significantly higher rate of Raymond-Roy Occlusion Classification class 1 immediately after treatment (30.0% vs 20.8%, P=0.003) and at 6 months (28.8% vs 20.0%, P=0.004) and a higher volume embolization ratio (27.2% (SD 6.5%) vs 25.9% (SD 6.2%), P=0.003). Re-treatment rates were not significantly different between the two groups (0.7% vs 0.2%, P=0.624). No significant differences in the incidences of ischemic and hemorrhagic complications and IMC-related parent artery dissection were found between the two groups. CONCLUSION Use of IMCs in triaxial systems can provide effective and safe support in coil embolization of UCAs because complete occlusion and dense coil packing can be achieved without increased complications.
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Affiliation(s)
- Michiyasu Fuga
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Ken Aoki
- Department of Neurosurgery, The Jikei University Katsushika Medical Center, Katsushika-ku, Tokyo, Japan
| | - Rintaro Tachi
- Department of Neurosurgery, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Koreaki Irie
- Department of Neurosurgery, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan
| | - Naoki Kato
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Issei Kan
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Shunsuke Hataoka
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Gota Nagayama
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Tohru Sano
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Toshihide Tanaka
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
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Chung J, Ko JH. An Efficient Method for Aneurysm Volume Quantification Applicable in Any Shape and Modalities. J Korean Neurosurg Soc 2021; 64:514-523. [PMID: 34185985 PMCID: PMC8273770 DOI: 10.3340/jkns.2020.0255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/14/2020] [Indexed: 02/08/2023] Open
Abstract
Objective Aneurysm volume quantification (AVQ) using the equation of ellipsoid volume is widely used although it is inaccurate. Furthermore, AVQ with 3-dimensional (3D) rendered data has limitations in general use. A novel universal method for AVQ is introduced for any diagnostic modality and application to any shape of aneurysms.
Methods Relevant AVQ studies published from January 1997 to June 2019 were identified to determine common methods of AVQ. The basic idea is to eliminate the normal artery volume from 3D model with the aneurysm. After Digital Imaging and Communications in Medicine (DICOM) data is converted and exported to stereolithography (STL) file format, the 3D STL model is modified to remove the aneurysm and the volume difference between the 3D model with/without the aneurysm is defined as the aneurysm volume. Fifty randomly selected aneurysms from DICOM database were used to validate the different AVQ methods.
Results We reviewed and categorized AVQ methods in 121 studies. Approximately 60% used the ellipsoid method, while 24% used the 3D model. For 50 randomly selected aneurysms, volumes were measured using 3D Slicer, RadiAnt, and ellipsoid method. Using 3D Slicer as the reference, the ratios of mean difference to mean volume obtained by RadiAnt and ellipsoid method were -1.21±7.46% and 4.04±30.54%, respectively. The deviations between RadiAnt and 3D Slicer were small despite of aneurysm shapes, but those of ellipsoid method and 3D Slicer were large.
Conclusion In spite of inaccuracy, ellipsoid method is still mostly used. We propose a novel universal method for AVQ that is valid, low cost, and easy to use.
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Affiliation(s)
- Jaewoo Chung
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
| | - Jung Ho Ko
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
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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: 6] [Impact Index Per Article: 2.0] [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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Chen PR, Lopez-Rivera V, Conner CR, Sanzgiri A, Sheth SA, Erkmen K, Kim DH, Day AL. Utility of skull X-rays in identifying recurrence of coiled cerebral aneurysms. J Cerebrovasc Endovasc Neurosurg 2021; 23:108-116. [PMID: 33902273 PMCID: PMC8256019 DOI: 10.7461/jcen.2021.e2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/15/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE A high rate of cerebral aneurysm recurrence following endovascular coiling has prompted the use of digital subtraction angiography (DSA) for interval follow-up. However, the utility of skull x-rays as an alternative screening method for aneurysm recurrence is unproperly characterized. METHODS Retrospective review of a prospective registry of ruptured and unruptured cerebral aneurysms. Anteroposterior and lateral skull x-rays were obtained immediately at the end of the procedure and at 6-month follow-up. Aneurysm recurrence was defined by comparing post-procedure and 6-month DSA imaging. A true positive was defined as a change in coil mass morphology on at least one projection with aneurysm recurrence on DSA, and a true negative defined as a stable coil mass on both projections and no recurrence on DSA. Receiver operating characteristic area under the curve (AUC) statistics was used to assess the performance of skull x-rays in identifying aneurysm recurrence. RESULTS A total of 118 cerebral aneurysms were evaluated with DSA imaging and skull x-rays. A change in coil mass morphology on one projection of skull x-rays correctly detected all true recurrences with a sensitivity of 100% (95% confidence interval [CI], 91-100%). Skull x-rays failed to identify a stable aneurysm coil mass in 15 cases, with a specificity of 79% (68-88%). Skull x-rays performed with AUC 0.8958 (95% CI, 0.8490-0.9431) in identifying aneurysm recurrence. CONCLUSIONS The findings of our study suggest that skull x-rays may represent a lowcost, non-invasive screening tool to rule out aneurysm recurrence, which can potentially aid in decreasing the utilization of DSA in the follow-up of patients with coiled cerebral aneurysms.
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Affiliation(s)
- Peng Roc Chen
- Department of Neurosurgery, University of Texas McGovern Medical School, Houston, TX, USA
| | - Victor Lopez-Rivera
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Christopher R Conner
- Department of Neurosurgery, University of Texas McGovern Medical School, Houston, TX, USA
| | - Aditya Sanzgiri
- Department of Neurosurgery, University of Texas McGovern Medical School, Houston, TX, USA
| | - Sunil A Sheth
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Kadir Erkmen
- Department of Neurosurgery, Temple University, Philadelphia, PA, USA
| | - Dong H Kim
- Department of Neurosurgery, University of Texas McGovern Medical School, Houston, TX, USA
| | - Arthur L Day
- Department of Neurosurgery, University of Texas McGovern Medical School, Houston, TX, USA
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Role of radiation therapy in primary central nervous system lymphoma. J Neurooncol 2017; 135:629-638. [DOI: 10.1007/s11060-017-2616-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 09/04/2017] [Indexed: 12/18/2022]
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Murayama Y. Innovation in Neurosurgery: Intellectual Property Strategy and Academia/Industrial Collaboration. Neurol Med Chir (Tokyo) 2016; 56:569-73. [PMID: 27298262 PMCID: PMC5027239 DOI: 10.2176/nmc.st.2016-0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Neurosurgery has tremendous possibilities for development of innovative medical devices. However, most of the neurosurgical devices used in Japan are imported products. Promotion and development of domestic medical devices is highly encouraged and it is one of the pillars of Prime Minister Shinzo Abe's growth strategy of Japanese economy. Innovative "Made in Japan" medical devices can be developed by interdisciplinary collaboration between industries and academic institutions. Proper orientation of medical and engineering education, social and administrative awareness of the need of facilitating the medical devices creative process with corresponding regulatory changes, and appropriate medical and technological infrastructure establishment are needed for stimulating medical device innovation.
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Affiliation(s)
- Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine
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Mitome-Mishima Y, Oishi H, Yamamoto M, Yatomi K, Nonaka S, Miyamoto N, Urabe T, Arai H. Differences in tissue proliferation and maturation between Matrix2 and bare platinum coil embolization in experimental swine aneurysms. J Neuroradiol 2015; 43:43-50. [PMID: 26024771 DOI: 10.1016/j.neurad.2015.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE Recanalization of post-embolization cerebral aneurysms remains a serious problem that influences treatment outcomes. Matrix2 is a bioactive, bio-absorbable, detachable coil that was developed to reduce the risk of recanalization. We examined the short-term efficacy of the Matrix2 coil system, and evaluated the temporal profile of tissue proliferation in a swine experimental aneurysm model compared with the bare platinum (BP) coil. MATERIALS AND METHODS Thirty-six experimental aneurysms were created in 18 swine. All aneurysms were tightly packed with Matrix2 or BP coils. Comparative histologic and morphologic analyses were undertaken 1, 2 and 4 weeks post-embolization. RESULTS Endothelial-like cells were observed partially lining the aneurysmal opening one week post-embolization with both coil types. At two and four weeks post-embolization, the aneurysms treated with Matrix2 coils had more extensive areas of organized thrombus than those packed with BP coils, but the numbers of functional proliferating endothelial cells identified by immunohistochemistry in the tissue were broadly comparable between the groups. Moreover, morphological analysis suggested there were more mature endothelial cells in aneurysms treated with bare platinum rather than Matrix2 coils. CONCLUSIONS Our results indicate that aneurysms embolized with Matrix2 coils build thicker scaffolds for endothelialization, but this is not necessarily evidence of earlier tissue proliferation and maturation than those embolized with BP coils. Matrix2 coils may not be superior to BP coils for preventing aneurysmal recanalization after endovascular treatment of cerebral aneurysms.
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Affiliation(s)
| | - Hidenori Oishi
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Neuroendovascular Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | - Munetaka Yamamoto
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Yatomi
- Department of Neurosurgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Senshu Nonaka
- Department of Neurosurgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Nobukazu Miyamoto
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
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Rodriguez JN, Hwang W, Horn J, Landsman TL, Boyle A, Wierzbicki MA, Hasan SM, Follmer D, Bryant J, Small W, Maitland DJ. Design and biocompatibility of endovascular aneurysm filling devices. J Biomed Mater Res A 2014; 103:1577-94. [PMID: 25044644 DOI: 10.1002/jbm.a.35271] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/01/2014] [Accepted: 06/12/2014] [Indexed: 12/13/2022]
Abstract
The rupture of an intracranial aneurysm, which can result in severe mental disabilities or death, affects approximately 30,000 people in the United States annually. The traditional surgical method of treating these arterial malformations involves a full craniotomy procedure, wherein a clip is placed around the aneurysm neck. In recent decades, research and device development have focused on new endovascular treatment methods to occlude the aneurysm void space. These methods, some of which are currently in clinical use, utilize metal, polymeric, or hybrid devices delivered via catheter to the aneurysm site. In this review, we present several such devices, including those that have been approved for clinical use, and some that are currently in development. We present several design requirements for a successful aneurysm filling device and discuss the success or failure of current and past technologies. We also present novel polymeric-based aneurysm filling methods that are currently being tested in animal models that could result in superior healing.
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Affiliation(s)
- Jennifer N Rodriguez
- Department of Biomedical Engineering, Texas A&M University, 3120 TAMU, College Station, Texas, 77843
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Hamada K, Miura Y, Toma N, Miyamoto K, Imanaka-Yoshida K, Matsushima S, Yoshida T, Taki W, Suzuki H. Gellan sulfate core platinum coil with tenascin-C promotes intra-aneurysmal organization in rats. Transl Stroke Res 2014; 5:595-603. [PMID: 24939607 DOI: 10.1007/s12975-014-0352-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/11/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
Abstract
The aims of this study were to develop a new coil, gellan sulfate core platinum coil (GSCC), that delivers tenascin-C (TNC) to an aneurysm (GSCC-TNC) and to evaluate the effects on intra-aneurysmal organization. We performed in vitro adsorption tests of TNC to gellan sulfate (GS). GSCC-TNC was produced by immersing GSCC in TNC solution under the following conditions (TNC concentration 10, 50, or 100 μg/mL; TNC immersion time 15, 30, or 60 min) by monitoring intra-aneurysmal organization in a rat blind-ended aneurysm model. In addition, 20 rats randomly underwent implantation of a platinum coil or the GSCC-TNC produced under optimum conditions into an aneurysm, whose organization effects were compared in a blind fashion at 2 weeks post-surgery. GS demonstrated a high affinity to TNC in a dose-dependent fashion (affinity constant = 1.79 × 10(10) (M(-1))). GSCC immersed in 10 μg/mL of TNC solution for 30 and 60 min induced similar and better organization of aneurysmal cavity compared with that for 15 min (the ratio of the organized areas in an aneurysmal cavity-15 min, 27.2 ± 11.8 %; 30 min, 75.6 ± 11.9 %; 60 min, 82.6 ± 19.7 %, respectively) with the preservation of the aneurysmal wall structure, while higher TNC concentrations caused the destruction of the aneurysmal wall. GSCC-TNC produced under 10 μg/mL of TNC solution for 30 min showed a significantly better organization of aneurysms compared with bare platinum coils in rats. A newly developed coil, GSCC-TNC, may be effective for improving intra-aneurysmal organization after coil embolization.
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Affiliation(s)
- Kazuhide Hamada
- Department of Neurosurgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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McDougall CG, Johnston SC, Gholkar A, Barnwell SL, Vazquez Suarez JC, Massó Romero J, Chaloupka JC, Bonafe A, Wakhloo AK, Tampieri D, Dowd CF, Fox AJ, Imm SJ, Carroll K, Turk AS. Bioactive versus bare platinum coils in the treatment of intracranial aneurysms: the MAPS (Matrix and Platinum Science) trial. AJNR Am J Neuroradiol 2014; 35:935-42. [PMID: 24481333 DOI: 10.3174/ajnr.a3857] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The ability of polymer-modified coils to promote stable aneurysm occlusion after endovascular treatment is not well-documented. Angiographic aneurysm recurrence is widely used as a surrogate for treatment failure, but studies documenting the correlation of angiographic recurrence with clinical failure are limited. This trial compares the effectiveness of Matrix(2) polyglycolic/polylactic acid biopolymer-modified coils with bare metal coils and correlates the angiographic findings with clinical failure (ie, target aneurysm recurrence), a composite end point that includes any incident of posttreatment aneurysm rupture, retreatment, or unexplained death. MATERIALS AND METHODS This was a multicenter randomized noninferiority trial with blinded end point adjudication. We enrolled 626 patients, divided between Matrix(2) and bare metal coil groups. The primary outcome was target aneurysm recurrence at 12 ± 3 months. RESULTS At 455 days, at least 1 target aneurysm recurrence event had occurred in 14.6% of patients treated with bare metal coils and 13.3% of Matrix(2) (P = .76, log-rank test) patients; 92.8% of target aneurysm recurrence events were re-interventions for aneurysms that had not bled after treatment, and 5.8% of target aneurysm recurrence events resulted from hemorrhage or rehemorrhage, with or without retreatment. Symptomatic re-intervention occurred in only 4 (0.6%) patients. At 455 days, 95.8% of patients with unruptured aneurysms and 90.4% of those with ruptured aneurysms were independent (mRS ≤ 2). Target aneurysm recurrence was associated with incomplete initial angiographic aneurysm obliteration, presentation with rupture, and a larger aneurysmal dome and neck size. CONCLUSIONS Tested Matrix(2) coils were not inferior to bare metal coils. Endovascular coiling of intracranial aneurysms was safe, and the rate of technical success was high. Target aneurysm recurrence is a promising clinical outcome measure that correlates well with established angiographic measurements.
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Affiliation(s)
- C G McDougall
- From the Department of Neurosurgery (C.G.M.), Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | - A Gholkar
- Department of Neuroradiology (A.G.), Regional Neurosciences Center, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - S L Barnwell
- Departments of Neurological Surgery and Diagnostic Radiology (S.L.B.), Oregon Health and Science University, Portland, Oregon
| | - J C Vazquez Suarez
- Therapeutic Neuroradiology Unit (J.C.V.S.), University General Hospital of Alicante, Alicante, Spain
| | - J Massó Romero
- Department of Interventional Neuroradiology (J.M.R.), Hospital Donostia, San Sebastián, Spain
| | - J C Chaloupka
- Department of Neurosurgery and Radiology (J.C.C.), Mount Sinai Medical Center, Miami Beach, Florida
| | - A Bonafe
- Service de Neuroradiologie (A.B.), Hôspital Gui de Chauliac, Montpellier Cedex, France
| | - A K Wakhloo
- Division of Neuroimaging and Intervention (A.K.W.), Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - D Tampieri
- Department of Diagnostic and Interventional Neuroradiology (D.T.), Montreal Neurological Institute, Montreal, Canada
| | - C F Dowd
- Department of Radiology (C.F.D.), University of California, San Francisco, San Francisco, California
| | - A J Fox
- Department of Neuroradiology (A.J.F.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - S J Imm
- Stryker Corporation (S.J.I., K.C.), Fremont, California
| | - K Carroll
- Stryker Corporation (S.J.I., K.C.), Fremont, California
| | - A S Turk
- Departments of Neurointerventional Surgery, Radiology, and Neurosurgery (A.S.T.), Medical University of South Carolina, Charleston, South Carolina
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Fargen KM, Blackburn S, Deshaies EM, Carpenter JS, Jabbour P, Mack WJ, Rai AT, Siddiqui AH, Turner RD, Mocco J. Final results of the multicenter, prospective Axium MicroFX for Endovascular Repair of IntraCranial Aneurysm Study (AMERICA). J Neurointerv Surg 2014; 7:40-3. [DOI: 10.1136/neurintsurg-2013-011049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fargen KM, Blackburn S, Carpenter JS, Jabbour P, Mack WJ, Rai AT, Siddiqui AH, Turner RD, Mocco J. Early results of the Axium MicroFX for Endovascular Repair of IntraCranial Aneurysm (AMERICA) study: a multicenter prospective observational registry. J Neurointerv Surg 2013; 6:495-9. [PMID: 24026950 DOI: 10.1136/neurintsurg-2013-010887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Axium MicroFX coils contain polymer (polyglycolic/polylactic acid, PGLA) microfilaments designed to significantly impact intra-aneurysmal flow and to encourage aneurysm thrombosis. To provide preliminary evaluation of the safety and suggested efficacy of the MicroFX design, we performed a multicenter prospective single-arm trial, Axium MicroFX for Endovascular Repair of IntraCranial Aneurysm study (AMERICA). METHODS AMERICA is a prospective multicenter 100 aneurysm observational study evaluating the safety and efficacy of Axium MicroFX PGLA coils. Enrollment was started in April 2010 and completed in October 2012. RESULTS 99 patients underwent treatment for 100 aneurysms at 13 centers. Mean age was 60.2 years, most were women (72%) and 18% of patients had previously undergone treatment for a separate aneurysm. 22% of patients underwent treatment after acute aneurysmal subarachnoid hemorrhage (SAH). Of these patients, all were Hunt and Hess grade 1-3. Pre-procedure modified Rankin score (mRS) was 0-2 in 92% of patients. The majority of aneurysms were anterior circulation (86%), with the most common aneurysm locations being the anterior communicating artery (23%) followed by the supraclinoid internal carotid artery and posterior communicating artery (18% each). The mean maximum diameter was 6.5 mm. Axium MicroFX coils could be placed in all but one treatment (99%). Raymond grade at conclusion of coiling was I (complete) in 52%, II (dog ear or residual neck) in 33% and III (residual aneurysm) in 15%. Discharge mRS was significantly worse in patients with SAH (62% mRS 0-2) compared with electively treated aneurysms (mRS 0-2 in 94%, p<001). Major events were uncommon (6% thromboembolic events, 3% intraoperative vessel or aneurysm rupture) and device-related adverse events (AE) were rare (2% of cases). CONCLUSIONS This prospective study of Axium MicroFX coils demonstrates excellent aneurysm occlusion rates. 52% of aneurysms were completely occluded post-procedure. Within the ruptured aneurysm group, post-procedure occlusion rates were 63.6%. Major AE rates were consistent with historical data.
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Affiliation(s)
- Kyle M Fargen
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Spiros Blackburn
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Jeffrey S Carpenter
- Department of Radiology, West Virginia School of Medicine, Morgantown, West Virginia, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - William J Mack
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Ansaar T Rai
- Department of Radiology, West Virginia School of Medicine, Morgantown, West Virginia, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - Raymond D Turner
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - J Mocco
- Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, USA
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Rezek I, Mousan G, Wang Z, Murad MH, Kallmes DF. Coil type does not affect angiographic follow-up outcomes of cerebral aneurysm coiling: a systematic review and meta-analysis. AJNR Am J Neuroradiol 2013; 34:1769-73. [PMID: 23660290 DOI: 10.3174/ajnr.a3598] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies varied in their conclusions about the superiority of second-generation coils compared with bare platinum. In this systematic review and meta-analysis, we assessed differences in reported unfavorable angiographic outcomes of cerebral aneurysms treated with coil embolization as a function of coil type. MATERIALS AND METHODS This systematic review covered 1999-2011 through the use of Ovid MEDLINE and EMBASE. Search terms were "subarachnoid hemorrhage," "intracranial aneurysms," "endovascular treatment," and "coiling." Inclusion criteria were studies reporting >50 aneurysms with imaging follow-up. We defined "unfavorable angiographic outcome" as either "recanalization," <90% occlusion, or "incomplete occlusion" at follow-up. Rates of unfavorable outcomes were pooled through the use of random effects models and compared across various coil types. Multivariate random effects meta-regression models were used to further explore the differences in outcomes related to coil type. RESULTS We included 82 studies, comprising 90 patient cohorts, among which, 65 (72%) used bare platinum coils, 8 (8.9%) used Matrix, 11 (12%) used HydroCoil, and 6 (6.7%) used Cerecyte. The overall unfavorable outcome rate was 19% (95% CI: 17%,21%). Unfavorable outcome rates were 20% (95% CI: 17%, 22%) for bare platinum coils, 23% (95% CI: 16%, 29%) for Matrix, 15% (95% CI: 9%, 21%) for HydroCoil, and 15% (95% CI: 7%, 23%) for Cerecyte, respectively. The difference in unfavorable outcome rates among the various coil types was not statistically significant after adjusting for baseline characteristics, including aneurysm size, rupture status, and follow-up duration. CONCLUSIONS The rate of unfavorable angiographic outcomes was not statistically different across the major approved coil types. The quality of the evidence, however, remains low because of high heterogeneity, small sample size, and potential publication bias.
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Agner C, Dujovny M. Historical evolution of neuroendovascular surgery of intracranial aneurysms: from coils to polymers. Neurol Res 2013; 31:632-7. [DOI: 10.1179/174313209x455790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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17
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Tiny aneurysms treated with single coil: Morphological comparison between bare platinum coil and matrix coil. Clin Neurol Neurosurg 2013; 115:529-34. [DOI: 10.1016/j.clineuro.2012.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 05/13/2012] [Accepted: 05/27/2012] [Indexed: 11/22/2022]
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18
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Vanzin JR, Mounayer C, Abud DG, D'agostini Annes R, Moret J. Angiographic results in intracranial aneurysms treated with inert platinum coils. Interv Neuroradiol 2012; 18:391-400. [PMID: 23217634 DOI: 10.1177/159101991201800405] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 04/08/2012] [Indexed: 11/17/2022] Open
Abstract
This study was designed in an attempt to identify the risk factors that could be significantly associated with angiographic recurrences after selective endovascular treatment of aneurysms with inert platinum coils. A retrospective analysis of all patients with selective endovascular coil occlusion of intracranial aneurysms was prospectively collected from 1999 to 2003. There were 455 aneurysms treated with inert platinum coils and followed by digital subtraction angiography. Angiographic results were classified according Roy and Raymond's classification. Recurrences were subjectively divided into minor and major. The most significant predictors for angiographic recurrences were determined by ANOVAs logistic regression, Cochran-Mantel-Haenszel test, Fisher exact probability. Short-term (4.3 ± 1.4 months) follow-up angiograms were available in 377 aneurysms, middle-term (14.1 ± 4.0 months) in 327 and long-term (37.4 ± 11.5 months) in 180. Recurrences were found in 26.8% of treated aneurysms with a mean of 21 ± 15.7 months of follow-up. Major recurrences needing retreatment were present in 8.8% during a mean period follow-up of 17.9 ± 12.29 months after the initial endovascular treatment. One patient (0.2%) experienced a bleed during the follow-up period. Recurrences after endovascular treatment of aneurysms with inert platinum coils are frequent, but hemorrhages are unusual. Single aneurysm, ruptured aneurysm, neck greater than 4 mm and time of follow-up were risk factors for recurrence after endovascular treatment. The retreatment of recurrent aneurysm decreases the risk of major recurrences 9.8 times. Long-term angiogram monitoring is necessary for the population with significant recurrence predictors.
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Affiliation(s)
- J R Vanzin
- Interventional Neuroradiology, Neurology and Neurosurgery Service, Passo Fundo, Brazil
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Waldau B, Fargen KM, Mack WJ, Wilson NM, Khaldi A, Hoh BL, Mocco J. Axium MicroFX coil for the completing endovascular aneurysm surgery study (ACCESS). A prospective evaluation of the safety and durability of Axium MicroFX PGLA coils. Interv Neuroradiol 2012; 18:200-7. [PMID: 22681737 DOI: 10.1177/159101991201800213] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 12/27/2011] [Indexed: 11/17/2022] Open
Abstract
Recanalization of previously coiled aneurysms remains a major drawback of endovascular aneurysm therapy. We performed a prospective single arm trial to provide early initial data regarding the safety and angiographic durability of a new coil technology, the Axium MicroFX Polyglycolic/polylactic acid (PGLA) coil, which was designed to lower recanalization rates. Fifteen patients (16 aneurysms) were prospectively enrolled. Demographic and peri-procedural data were collected. Angiographic images of the initial coil embolization and three to six month follow-up angiographic images underwent blinded evaluation. Seven (47%) SAH and eight (53%) elective patients were enrolled. Blinded evaluation of the initial embolization demonstrated that 5/16 (31%) aneurysms achieved Raymond grade 1, 5/16 (31%) grade 2 and 6/16 (38%) grade 3. Three to six month angiography was obtained in 12/15 patients (80%); two patients expired (1 SAH, 1 elective) and one was lost to follow-up (SAH). All patients who underwent follow-up angiography had a mRS ≤1. Blinded evaluation of embolization demonstrated 7/13 aneurysms (54%) improved in Raymond grading, five (38%) were stable and one aneurysm (8%) worsened. One patient developed an asymptomatic peri-aneurysmal parent vessel stenosis. Axium MicroFX coils appear to be safe, though the small number of patients in this series obviates comparative analysis with other series. Further studies are needed with more patients to compare the angiographic durability of Axium MicroFX coils to other coils.
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Affiliation(s)
- B Waldau
- Department of Neurosurgery, University of Florida, Gainesville, FL 32610-0265, USA.
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20
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Moritz JLW, Vendrell JF, Hoa D, Menjot N, Costalat V, Brunel H, Bonafé A. Mid-term clinical and angiographic results of cerebral aneurisms treated with matrix2(®) coils. J Neuroradiol 2012; 39:326-31. [PMID: 22269816 DOI: 10.1016/j.neurad.2011.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 12/05/2011] [Accepted: 12/07/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate 1 year results of endovascular treatment (EVT) of intracranial aneurisms using Matrix second generation detachable coils (MSG(®)). PATIENTS AND METHODS Between January and December 2006, 32 patients with 32 intracranial aneurisms were treated by coiling using MSG(®), with a minimum follow-up of 1 year. Data were acquired prospectively. Exclusion criteria were: permanent adjunctive device, less than 50% MSG(®) length, and additional bioactive or coated coils. All procedures were carried out in a single institution. Six months and 1 year follow-up were performed with magnetic resonance angiography and digital subtraction angiography, respectively. We assessed radiological and clinical results using the modified Raymond classification, a 3-level longitudinal grading scale (LGS), Glasgow outcome and Rankin scales. RESULTS Thirteen (40.6%) male and 19 (59.4%) female underwent EVT using MSG(®) with a mean follow-up of 16.6 months. Ruptured aneurisms (75%) outnumbered unruptured. Immediate radiological results showed 15 complete occlusions (46.9%), 12 (37.5%) neck remnant, and five (15.6%) residual sac. In the mean time, six patients (18.7%) needed to be retreated due to insufficient initial packing or early recanalization. Using the LGS, a stable occlusion was observed in 40.7%, a progressive thrombosis in 25%, and 34.3% of the cases evolved unfavorably. Thirty-one patients had stable or improved clinical status, while one patient died from a thromboembolic event 1 month after retreatment (3.1% overall mortality). CONCLUSION At 1 year follow-up, MSG(®) demonstrated similar angiographic results compared to Matrix first generation coils and didn't suggest advantage over platinum coils.
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Affiliation(s)
- Jorge Luís Wollstein Moritz
- Division of Interventional Neuroradiology, Hôpital Gui de Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France.
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21
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Smith MJ, Mascitelli J, Santillan A, Brennan JS, Tsiouris AJ, Riina HA, Gobin YP. Bare platinum vs matrix detachable coils for the endovascular treatment of intracranial aneurysms: a multivariate logistic regression analysis and review of the literature. Neurosurgery 2011; 69:557-64; discussion 565. [PMID: 21499161 DOI: 10.1227/neu.0b013e31821a86da] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite increasing acceptance of endovascular coiling for treating intracranial aneurysms, incomplete occlusion remains a limitation. Attempts to reduce recanalization have prompted creation of polyglycolic/polylactic acid-coated (Matrix) coils shown to improve neointima formation; however, previous publications demonstrate conflicting results regarding their efficacy. Few studies account for factors influencing recurrence, and only 4 studies include bare platinum (BP) coil control groups. OBJECTIVE To compare initial and short- and mid-term occlusion as well as retreatment rates using Matrix compared with BP coils. METHODS Retrospective review of patients undergoing coiling of cerebral aneurysms from 2001 to 2005 was performed. Analysis included a multivariate logistic regression model designed to detect a 35% absolute difference in initial occlusion between coil treatment groups with 80% power. RESULTS Complete initial occlusion was achieved in 64% of BP (n = 45) and 63% of Matrix (n = 56) cases (P = 1.0). Follow-up occlusion rates in the short term and mid term were 52% and 60%, respectively, for BP cases and 42% and 67%, respectively, for Matrix cases (P = .24 and P = .38, respectively). After adjusting for size, morphology, volumetric packing density, location, rupture, and balloon remodeling, no difference in initial and subsequent occlusion or retreatment rates for BP coils versus Matrix coils was appreciated. CONCLUSION After controlling for factors influencing recanalization, this investigation failed to show a significant difference between coil groups.
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Affiliation(s)
- Michelle J Smith
- Division of Interventional Neuroradiology, Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, New York 10021, USA.
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22
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Sughrue ME, Saloner D, Rayz VL, Lawton MT. Giant intracranial aneurysms: evolution of management in a contemporary surgical series. Neurosurgery 2011; 69:1261-70; discussion 1270-1. [PMID: 21734614 PMCID: PMC3529163 DOI: 10.1227/neu.0b013e31822bb8a6] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Many significant microsurgical series of patients with giant aneurysms predate changes in practice during the endovascular era. OBJECTIVE A contemporary surgical experience is presented to examine changes in management relative to earlier reports, to establish the role of open microsurgery in the management strategy, and to quantify results for comparison with evolving endovascular therapies. METHODS During a 13-year period, 140 patients with 141 giant aneurysms were treated surgically. One hundred aneurysms (71%) were located in the anterior circulation, and 41 aneurysms were located in the posterior circulation. RESULTS One hundred eight aneurysms (77%) were completely occluded, 14 aneurysms (10%) had minimal residual aneurysm, and 16 aneurysms (11%) were incompletely occluded with reversed or diminished flow. Three patients with calcified aneurysms were coiled after unsuccessful clipping attempts. Eighteen patients died in the perioperative period (surgical mortality, 13%). Bypass-related complications resulted from bypass occlusion (7 patients), aneurysm hemorrhage due to incomplete aneurysm occlusion (4 patients), or aneurysm thrombosis with perforator or branch artery occlusion (4 patients). Thirteen patients were worse at late follow-up (permanent neurological morbidity, 9%; mean length of follow-up, 23 ± 1.9 months). Overall, good outcomes (Glasgow Outcome Score 5 or 4) were observed in 114 patients (81%), and 109 patients (78%) were improved or unchanged after therapy. CONCLUSION A heavy reliance on bypass techniques plus indirect giant aneurysm occlusion distinguishes this contemporary surgical experience from earlier ones, and obviates the need for hypothermic circulatory arrest. Experienced neurosurgeons can achieve excellent results with surgery as the "first-line" management approach and endovascular techniques as adjuncts to surgery.
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Affiliation(s)
- Michael E. Sughrue
- Department of Neurological Surgery University of California at San Francisco San Francisco, CA
| | - David Saloner
- Department of Radiology University of California at San Francisco San Francisco, CA
| | - Vitaliy L. Rayz
- Department of Radiology University of California at San Francisco San Francisco, CA
| | - Michael T. Lawton
- Department of Neurological Surgery University of California at San Francisco San Francisco, CA
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23
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Mohammadi AR, Chen K, Ali MSM, Takahata K. Radio aneurysm coils for noninvasive detection of cerebral embolization failures: a preliminary study. Biosens Bioelectron 2011; 30:300-5. [PMID: 22014417 DOI: 10.1016/j.bios.2011.09.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 09/23/2011] [Accepted: 09/24/2011] [Indexed: 11/27/2022]
Abstract
The rupture of a cerebral aneurysm is the most common cause of subarachnoid hemorrhage. Endovascular embolization of the aneurysms by implantation of Guglielmi detachable coils (GDC) has become a major treatment approach in the prevention of a rupture. Implantation of the coils induces formation of tissues over the coils, embolizing the aneurysm. However, blood entry into the coiled aneurysm often occurs due to failures in the embolization process. Current diagnostic methods used for aneurysms, such as X-ray angiography and computer tomography, are ineffective for continuous monitoring of the disease and require extremely expensive equipment. Here we present a novel technique for wireless monitoring of cerebral aneurysms using implanted embolization coils as radiofrequency resonant sensors that detect the blood entry. The experiments show that commonly used embolization coils could be utilized as electrical inductors or antennas. As the blood flows into a coil-implanted aneurysm, parasitic capacitance of the coil is modified because of the difference in permittivity between the blood and the tissues grown around the coil, resulting in a change in the coil's resonant frequency. The resonances of platinum GDC-like coils embedded in aneurysm models are detected to show average responses of 224-819 MHz/ml to saline injected into the models. This preliminary demonstration indicates a new possibility in the use of implanted GDC as a wireless sensor for embolization failures, the first step toward realizing long-term, noninvasive, and cost-effective remote monitoring of cerebral aneurysms treated with coil embolization.
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Affiliation(s)
- Abdolreza Rashidi Mohammadi
- Department of Electrical & Computer Engineering, University of British Columbia, Vancouver, BC, V6T 1Z4 Canada
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24
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Youn SW, Cha SH, Kang HS, Cho YD, Han MH. Matrix² coils in embolization of intracranial aneurysms: 1-year outcome and comparison with bare platinum coil group in a single institution. AJNR Am J Neuroradiol 2011; 32:1745-50. [PMID: 21920863 DOI: 10.3174/ajnr.a2579] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The endosaccular occlusion by using BPC has been useful in the treatment of intracranial aneurysms, but its limited durability remains a deep-seated drawback. The Matrix² coil, one of the bioactive-coated coils, had been developed to improve this limited durability. To evaluate durability of Matrix² coils after embolization of intracranial aneurysms, we retrospectively compared 1-year outcomes with that of BPC groups. MATERIALS AND METHODS A group of 121 aneurysms in 114 patients were embolized by using Matrix² coils between April 2006 and September 2008. The BPC group consisted of 151 aneurysms in 137 patients embolized by using BPCs alone between October 2007 and October 2008. The initial outcomes including packing densities, occlusion grades, and periprocedural complications, and the 1-year outcomes on MR angiography were retrospectively compared between the 2 groups. RESULTS The Matrix² coil group and BPC group with similar baseline demographic characteristics revealed comparable initial outcomes. The rates of overall recurrence, major recanalization, and retreatment were 17.4%, 14.0%, and 10.7% versus 7.3%, 5.3%, and 4.6%, respectively (P = .066). However, the rates of subgroups with aneurysm volumes between 50 and 200 mm³ were 23.7%, 13.1%, and 10.5% versus 2.2%, 0%, and 0% (P = .022), respectively. The rates of subgroups with packing attenuation <30% were 38.3%, 31.9%, and 23.4% versus 13.3%, 11.7%, and 10% (P = .025), respectively. There were no differences in packing attenuation (P = .152), initial occlusion grade (P = .098), and 1-year outcomes (P = .209) according to the length of Matrix² coils used. CONCLUSIONS Overall, initial and 1-year outcomes of the Matrix² coil group were comparable to those of the BPC group. However, in certain subgroups of aneurysm volume and packing attenuation, the 1-year durability of Matrix² coils was inferior to that of the BPC group.
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Affiliation(s)
- S W Youn
- Department of Radiology, Catholic University of Daegu Medical Center, Daegu, Korea
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25
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Takigawa T, Matsumaru Y, Nakai Y, Nakamura K, Hayakawa M, Tsuruta W, Matsumura A. Bioactive coils cause headache and fever after endovascular treatment of intracranial aneurysms. Headache 2011; 52:312-21. [PMID: 21797861 DOI: 10.1111/j.1526-4610.2011.01964.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Based on our encounters with patients who have been treated for unruptured intracranial aneurysms by endovascular coil embolization using bioactive coils, we observed that such patients often present with headaches and fever. OBJECTIVE The purpose of this study was to evaluate the incidence of headache and fever after coil embolization using bioactive coils. METHODS A database of 92 intracranial unruptured aneurysm patients (88 patients who did not have chronic headaches or migraines before treatment) on whom coil embolization had been performed between July 2007 and October 2010 was retrospectively assessed. Forty-five aneurysms (43 patients) were treated using bioactive coils and the other aneurysms were treated using bare coils. We analyzed the incidence and duration of headache, temperature, C-reactive protein, and white blood cell count before and after coil embolization and compared the 2 groups. RESULTS Forty-one patients (46.6%) reported onset of headaches just after treatment. Headache incidences were significantly greater in the patients treated with bioactive coils (bioactive coil group: 62.8% [27/43] vs bare coil group: 31.1% [14/45], P = .003), and the duration of headaches was significantly longer in the bioactive coil group (bioactive coil group: 3.44 ± 1.22 days vs bare coil group: 2.40 ± 1.17 days, P = .027). Seventy-one patients (80.7%) had incidences of fever (over 37°C) after treatment (bioactive coil group: 83.7% [36/43] vs bare coil group: 77.8% [35/45], P = .663). The duration of fever was significantly longer in the bioactive coil group (bioactive coil group: 2.9 ± 1.4 days vs bare coil group: 1.9 ± 1.1 days, P = .0017), and temperatures at 1, 2, or 3 days after treatment were significantly higher in the bioactive coil group (respective temperatures at 1, 2, 3 days after treatment: bioactive coil group: 37.42 ± 0.49, 37.19 ± 0.45, 37.00 ± 0.49 vs bare coil group: 37.14 ± 0.38, 36.96 ± 0.41, 36.63 ± 0.51, P = .009, P = .0246, P = .0032). There were no significant differences in C-reactive protein level and white blood cell count 1 and 3 days after treatment between 2 groups. CONCLUSIONS Bioactive coils induce headache and fever after coil embolization for intracranial aneurysms due to the inflammatory effects of polyglycolic acid used to accelerate aneurysm fibrosis and neointimal formation.
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Affiliation(s)
- Tomoji Takigawa
- Department of Neurosurgery, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan.
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Piotin M, Pistocchi S, Bartolini B, Blanc R. Intracranial aneurysm coiling with PGLA-coated coils versus bare platinum coils: long-term anatomic follow-up. Neuroradiology 2011; 54:345-8. [DOI: 10.1007/s00234-011-0870-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 04/05/2011] [Indexed: 11/29/2022]
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Interventional Neuroradiologic Therapy of Atherosclerotic Disease and Vascular Malformations. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10061-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Reinges MHT, Krings T, Drexler AY, Ludolph A, Sellhaus B, Bovi M, Geibprasert S, Agid R, Scherer K, Hans FJ. Bare, bio-active and hydrogel-coated coils for endovascular treatment of experimentally induced aneurysms. Long-term histological and scanning electron microscopy results. Interv Neuroradiol 2010; 16:139-50. [PMID: 20642888 DOI: 10.1177/159101991001600205] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 04/07/2010] [Indexed: 11/16/2022] Open
Abstract
Endovascular treatments of cerebral aneurysms with bare platinum coils have a higher rate of recurrence compared to surgical clipping. This may be related to failed vessel wall reconstruction since histological and scanning electron microscopy results following embolization failed to demonstrate neoendothelialization over the aneurysm neck. The present study tried to elucidate whether the use of modified coils resulted in a better rate of reconstructing the vessel wall over the aneurysm neck in experimental aneurysms. Aneurysms were created in 20 rabbits by intraluminal elastase incubation of the common carotid artery. Five animals each were assigned to the following groups: untreated, bare platinum coils, bioactive coils with polyglycolic/polylactic acid coating, and hydrogel-coated platinum coils. After 12 months, angiography, histology and scanning electron microscopy was performed. No neoendothelial layer was visualized in the bioactive and bare coil groups with a tendency to an increased layering of fibroblasts along the bioactive coils at the aneurysm fundus. However, at the aneurysm neck perfused clefts were present and although a thin fibrinous layer was present over some coils, no bridging neointimal or neoendothial layer was noted over different coils. Following loose Hydrogel coiling, a complete obliteration of the aneurysm was present with neoendothelialization present over different coil loops. The study demonstrates that with surface coil modifications complete and stable aneurysm obliteration may become possible. A smooth and dense surface over the aneurysm neck may be necessary for endothelial cells to bridge the aneurysm neck and to lead to vessel wall reconstruction.
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Affiliation(s)
- M H T Reinges
- University Hospital of the University of Technology, Aachen, Germany
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29
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Qian Y. A New Challenge to Estimate the Rupturing Process of ICA Aneurysms. Interv Neuroradiol 2010. [DOI: 10.1177/15910199100160s114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Y Qian
- Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
- Neurosurgery Department, Jikei University School of Medicine, Tokyo, Japan
- Centre for Advanced Biomedical Science, Tokyo, Japan
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D'Agostino SJ, Harrigan MR, Chalela JA, Nicholas JS, Deveikis SI, Jones TM, Deveikis JP. Clinical experience with Matrix2 360 degrees coils in the treatment of 100 intracranial aneurysms. ACTA ACUST UNITED AC 2009; 72:41-7. [PMID: 19559926 DOI: 10.1016/j.surneu.2009.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Indexed: 11/15/2022]
Abstract
BACKGROUND The M2-360 degrees is a recent class of aneurysm coil. This device combines the second generation of bioactive copolymer coating, which is intended to promote aneurysm fibrosis, with the "360 degrees " design, which is meant to improve uniformity and density of packing. This study evaluates the safety and angiographic stability of these devices. METHODS This was a retrospective review of 86 consecutive patients with 100 intracranial aneurysms that were treated using M2-360 degrees s. Follow-up was done at 6 and 12 months. RESULTS Seventy-eight aneurysms were coiled solely with M2-360 degrees s, and 22 aneurysms were treated with a combination of coils. In mixed-coil cases, the average percentage of coil volume consisting of M2-360 degrees coils was 78%. Procedure-related neurologic complications occurred in 6 patients (7%). Initial complete occlusion was obtained in 80 aneurysms. Of 76 aneurysms with 6-month angiographic follow-up, 4 (5.3%) revealed further occlusion, 54 (71.1%) were unchanged, and 18 (23.7%) showed recanalization. Of 38 aneurysms with 12-month follow-up, 1 (2.6%) revealed further occlusion, 23 (60.5%) were unchanged, and 14 (36.8%) showed recanalization. Six- and 12-month angiograms showed major recanalization (requiring further coiling) in 3.9% and 15.8% of cases, respectively. CONCLUSIONS The risk of complications with M2-360 degrees -treated aneurysms is comparable with reports of other coils, indicating that M2-360 degrees s are relatively safe. Although the initial occlusion rate is higher than that in other coiling series, recanalization rates were similar to those obtained with other coil designs. This study does not demonstrate an advantage with M2-360 degrees s.
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Affiliation(s)
- Sabino J D'Agostino
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC 29425, USA
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31
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Ferns SP, Sprengers MES, van Rooij WJ, Rinkel GJE, van Rijn JC, Bipat S, Sluzewski M, Majoie CBLM. Coiling of intracranial aneurysms: a systematic review on initial occlusion and reopening and retreatment rates. Stroke 2009; 40:e523-9. [PMID: 19520984 DOI: 10.1161/strokeaha.109.553099] [Citation(s) in RCA: 323] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The proportion of incompletely occluded aneurysms after coiling varies widely between studies. To assess overall outcome of coiling, we systematically reviewed the literature to determine initial occlusion, reopening, and retreatment rates of coiled aneurysms according to predefined criteria and subgroups. METHODS We searched PubMed and EMBASE (January 1999 to September 2008) for studies of >50 coiled aneurysms. Two reviewers independently extracted data. We grouped studies reporting on only ruptured aneurysms, posterior circulation aneurysms, and studies with large proportions of aneurysms >10 mm to assess possible determinants for incomplete occlusion, reopening, and retreatment. RESULTS Forty-six studies totalling 8161 coiled aneurysms met inclusion criteria. Immediately after coiling, 91.2% (95% CI, 90.6% to 91.9%) of the aneurysms were adequately occluded. Aneurysm reopening occurred in 20.8% (95% CI, 19.8% to 21.9%) and retreatment was performed in 10.3% (95% CI, 9.5% to 11.0%). Reopening rate was lower in studies reporting on ruptured aneurysms only compared with all studies (11.4% versus 20.8%; relative risk, 0.55; 95% CI, 0.47 to 0.64) and higher in studies focusing on posterior circulation aneurysms compared with studies with >85% anterior circulation aneurysms (22.5% versus 15.5%; relative risk, 1.5; 95% CI,1.2 to 1.7). Regression analysis showed higher retreatment rates with increasing proportion of aneurysms >10 mm (beta=0.252; 95% CI, 0.073 to 0.432). We could not find a relation between reopening and type of coils used. CONCLUSIONS At follow-up, one fifth of all coiled intracranial aneurysms shows reopening of which half is retreated. Possible risk factors for aneurysm reopening are location in the posterior circulation and size >10 mm. To confirm our findings, a meta-analysis on individual well-reported patient data is desirable.
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Affiliation(s)
- Sandra P Ferns
- Department of Radiology, Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Piske RL, Kanashiro LH, Paschoal E, Agner C, Lima SS, Aguiar PH. EVALUATION OF ONYX HD-500 EMBOLIC SYSTEM IN THE TREATMENT OF 84 WIDE-NECK INTRACRANIAL ANEURYSMS. Neurosurgery 2009; 64:E865-75; discussion E875. [DOI: 10.1227/01.neu.0000340977.68347.51] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
We report our results using Onyx HD-500 (Micro Therapeutics, Inc., Irvine, CA) in the endovascular treatment of wide-neck intracranial aneurysms, which have a high rate of incomplete occlusion and recanalization with platinum coils.
METHODS
Sixty-nine patients with 84 aneurysms were treated. Most of the aneurysms were located in the anterior circulation (80 of 84 aneurysms), were unruptured (74 of 84 aneurysms), and were incidental. Ten presented with subarachnoid hemorrhage, and 15 were symptomatic. All aneurysms had wide necks (neck >4 mm and/or dome-to-neck ratio <1.5). Fifty aneurysms were small (<12 mm), 30 were large (12 to <25 mm) and 4 were giant. Angiographic follow-up was available for 65 of the 84 aneurysms at 6 months, for 31 of the 84 aneurysms at 18 months, and for 5 of the 84 aneurysms at 36 months.
RESULTS
Complete aneurysm occlusion was seen in 65.5% of aneurysms on immediate control, in 84.6% at 6 months, and in 90.3% at 18 months. The rates of complete occlusion were 74%, 95.1%, and 95.2% for small aneurysms and 53.3%, 70%, and 80% for large aneurysms at the same follow-up periods. Progression from incomplete to complete occlusion was seen in 68.2% of all aneurysms, with a higher percentage in small aneurysms (90.9%). Aneurysm recanalization was observed in 3 patients (4.6%), with retreatment in 2 patients (3.3%). Procedural mortality was 2.9%. Overall morbidity was 7.2%.
CONCLUSION
Onyx embolization of intracranial wide-neck aneurysms is safe and effective. Morbidity and mortality rates are similar to those of other current endovascular techniques. Larger samples and longer follow-up periods are necessary.
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Affiliation(s)
- Ronie L. Piske
- Section of Interventional Neuroradiology, Med Imagem, Hospital Beneficencia Portuguesa, São Paulo, Brazil
| | - Luis H. Kanashiro
- Section of Interventional Neuroradiology, Med Imagem, Hospital Beneficencia Portuguesa, São Paulo, Brazil
| | - Eric Paschoal
- Section of Interventional Neuroradiology, Med Imagem, Hospital Beneficencia Portuguesa, São Paulo, Brazil
| | - Celso Agner
- Department of Neurology, Advocate Trinity Hospital, Chicago, Illinois
| | - Sergio S. Lima
- Section of Interventional Neuroradiology, Med Imagem, Hospital Beneficencia Portuguesa, São Paulo, Brazil
| | - Paulo H. Aguiar
- Department of Neurology, Division of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil
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Occlusion of neck remnant in experimental rat aneurysms after treatment with platinum- or polyglycolic-polylactic acid–coated coils. ACTA ACUST UNITED AC 2009; 71:458-65; discussion 465. [DOI: 10.1016/j.surneu.2007.12.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Accepted: 12/19/2007] [Indexed: 11/21/2022]
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Yu SCH, So WK, Chung ACS, Lee KT, Wong GKC. A compartmentalized volumetric system for outcome analysis of coiled cerebral aneurysms: aneurysm-coil mass-neck outcome assessment system. Neurosurgery 2009; 64:149-54; discussion 154-5. [PMID: 19145163 DOI: 10.1227/01.neu.0000333260.55561.0d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Current methodologies for outcome assessment of coiled cerebral aneurysms are based on rough estimations. The aim of this study was to develop a system of quantitative analysis for objective and accurate assessment of the outcome of cerebral aneurysms treated with coil embolization. METHODS The quantitative analysis system is based on a concept of a perfect vessel tube and compartmentalized analysis of a coiled aneurysm. Based on the volumetric data of 3-dimensional radiographic angiography of the aneurysm and its associated parent vessel, a 2-step volume extraction method, including a global thresholding method and an augmented vessel method, is used for volume calculation. The coiled aneurysm (A) is compartmentalized into 2 volumetric components for quantitative analysis: 1) the volume of the coil mass (C), and 2) the volume of the uncoiled neck of the aneurysm (N). Changes in the volumetric data of the compartments A, C, and N at the time of follow-up provide a basis for outcome analysis. To test the clinical applicability of the system, the volumetric data for 21 consecutive cases of cerebral aneurysms in which a residual or recurrent cavity at the neck region was noted at the time of the 6-month follow-up evaluation were assessed with the aneurysm-coil mass-neck (ACN) outcome assessment system. RESULTS The results of the outcome analysis of the 21 cases according to the ACN system correlated well with angiographic assessment of treatment outcome. CONCLUSION The ACN outcome assessment system is a useful diagnostic instrument for objective and accurate assessment of the outcome of cerebral aneurysms treated with coil embolization.
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Affiliation(s)
- Simon C H Yu
- Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Castro E, Villoria F, Castaño C, Romance A, Mendez JC, Barrena R, Fortea F. Spanish Registry for Embolization of Small Intracranial Aneurysms with Cerecyte Coils (SPAREC) Study. Early Experience and Mid-Term Follow-up Results. Interv Neuroradiol 2009; 14:375-84. [PMID: 20557737 DOI: 10.1177/159101990801400403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Accepted: 07/30/2008] [Indexed: 11/17/2022] Open
Abstract
SUMMARY This study aimed to report the results obtained in treating small ruptured and unruptured intracranial aneurysms using Cerecyte coils. A prospective, non-randomized multicenter registry operating in Spain with a reporting period between May 2005 and September 2007.We present clinical and angiographic results for 48 small aneurysms (26 ruptured, five with III cranial nerve paresis, and 17 incidental) that had undergone six months' follow-up. The volumetric percentage occlusion (VPO) achieved and percentage bioactive coils (PBC) used were assessed. No episodes of bleeding occurred during the follow-up period. The technical complication rate was 10.4% (five cases): four thromboembolic complications resolved with medication (8.3%) and one asymptomatic protrusion of a coil into the parent vessel. The clinical complication rate for the procedure was 2.1% (occlusion of the anterior choroidal artery in a ruptured anterior choroidal anaeurysm). Mean VPO was 25.2%. Balloon-assisted technique (BAT) was used in 60.4% of cases. The VPO was higher in the BAT-treated cases (P < 0.05). The overall six-month recanalization rate was 16.7% (12.5% minor and 4.2% major recanalizations). Neck size and VPO were unrelated to the recanalization rate. The PBC was higher in cases with progressive Deployment of the device is safe from the standpoint of periprocedural technical and clinical complications. No episodes of hemorrhage were recorded during follow-up. The sixmonth recanalization and retreatment rates compared favorably with most endovascular platinum and bioactive coil series.
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Affiliation(s)
- E Castro
- Departments of Radiology, Neuroradiology Units: Hospital Universitario Gregorio Marañón; Madrid, Spain -
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Pierot L, Leclerc X, Bonafé A, Bracard S. Endovascular treatment of intracranial aneurysms using Matrix coils: short- and mid-term results in ruptured and unruptured aneurysms. Neurosurgery 2008; 63:850-7; discussion 857-8. [PMID: 19005374 DOI: 10.1227/01.neu.0000327694.13261.df] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE A prospective multicenter registry was conducted in France to evaluate the safety and efficacy of Matrix coils (Boston Scientific Neurovascular, Fremont, CA). The short- and mid-term results are presented. METHODS From January to October 2004, 236 patients harboring ruptured (Group I) or unruptured (Group II) aneurysms were treated via an endovascular approach with Matrix coils and were included in this registry. In-hospital morbidity and mortality was determined. One-year clinical follow-up data were obtained in 218 patients (92.4%). One-year angiographic follow-up data were obtained in 165 patients (171 aneurysms, 70.1%). RESULTS In Group I, in-hospital morbidity and mortality rates were 5.8 and 6.5%, respectively, with a procedure-related morbidity and mortality of 3.6 and 1.4%, respectively. At 1 year, the morbidity and mortality rates were 2.4 and 11.0%, respectively. In Group II, procedure-related morbidity and mortality rates were 1.0 and 0.0%, respectively. At 1 year, the morbidity and mortality rates were 1.1 and 0%, respectively. For both groups, no bleeding or rebleeding was observed during the follow-up period. The only factor associated with an increased rate of complications was delay before treatment of more than 2 days after bleeding. Aneurysm recanalization was observed in 44 aneurysms (25.7%). CONCLUSION In-hospital and 1-year morbidity and mortality rates in patients harboring ruptured or unruptured aneurysms treated with Matrix coils were similar to those previously reported with the use of bare coils. The efficacy of Matrix coils to prevent aneurysm recanalization was not demonstrated, despite a high percentage of progressive thrombosis that suggests biological activity resulting from Matrix coils.
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Affiliation(s)
- Laurent Pierot
- Department of Neuroradiology, University of Reims, Reims, France.
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Ishii A, Murayama Y, Nien YL, Yuki I, Adapon PH, Kim R, Jahan R, Duckwiler G, Viñuela F. IMMEDIATE AND MIDTERM OUTCOMES OF PATIENTS WITH CEREBRAL ANEURYSMS TREATED WITH MATRIX1 AND MATRIX2 COILS. Neurosurgery 2008; 63:1071-7; discussion 1077-9. [PMID: 19008767 DOI: 10.1227/01.neu.0000334047.30589.13] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Recanalization after coil embolization of cerebral aneurysms remains a limitation of this progressively accepted modality. The Matrix detachable bioabsorbable coil (Boston Scientific Neurovascular, Natick, MA) was developed to overcome this limitation. We report a single-center experience using first- and second-generation Matrix coils.
METHODS
Immediate and midterm angiographic outcomes of 235 consecutive patients with 250 aneurysms treated with Matrix coils were reviewed retrospectively. The first 16 aneurysms included in the postmarket Acceleration of Connective Tissue Formation in Endovascular Aneurysm Repair (ACTIVE) study were treated exclusively with the Matrix coil, as per protocol. The next 234 aneurysms were treated in combination with bare platinum coils, stents, and the balloon-assisted technique. First-generation Matrix coils were used in 155 aneurysms (Matrix1 group) and second-generation Matrix coils were used in 79 aneurysms (Matrix2 group). Outcomes of the 3 groups were compared.
RESULTS
Immediate complete obliteration was achieved in 12.5% of the ACTIVE group aneurysms, 32.9% of the Matrix1 group, and 43.0% of the Matrix2 group. Overall, 87 (34.8%) aneurysms were completely occluded acutely. Procedure-related morbidity and mortality were 2.4 and 0%, respectively. Follow-up (median, 7.9 months) angiograms were obtained for 186 (74.4%) aneurysms. Complete obliteration of aneurysms was confirmed in 26.7% of the ACTIVE group, 53.4% of the Matrix1 group, and 64.2% of the Matrix2 group. Recanalization was observed in 33.3% of the ACTIVE group, 16.9% of the Matrix1 group, and 9.4% of the Matrix2 group. The overall recanalization rate was 16.1%.
CONCLUSION
Use of Matrix2 coils resulted in improved mechanical performance and anatomic outcome compared with Matrix1 coils. However, practitioners must be familiar with the mechanical characteristics of the Matrix coils, which are different from those of bare platinum coils.
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Affiliation(s)
- Akira Ishii
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuichi Murayama
- Department of Radiology, Division of Interventional Neuroradiology, UCLA Medical Center, and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Yih-Lin Nien
- Department of Radiology, Division of Interventional Neuroradiology, UCLA Medical Center, and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Ichiro Yuki
- Department of Radiology, Division of Interventional Neuroradiology, UCLA Medical Center, and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - P. Henry Adapon
- Department of Radiology, Division of Interventional Neuroradiology, UCLA Medical Center, and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Robert Kim
- Department of Radiology, Division of Interventional Neuroradiology, UCLA Medical Center, and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Reza Jahan
- Department of Radiology, Division of Interventional Neuroradiology, UCLA Medical Center, and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Gary Duckwiler
- Department of Radiology, Division of Interventional Neuroradiology, UCLA Medical Center, and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
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Piotin M, Spelle L, Mounayer C, Loureiros C, Ghorbani A, Moret J. Intracranial aneurysms coiling with matrix: immediate results in 152 patients and midterm anatomic follow-up from 115 patients. Stroke 2008; 40:321-3. [PMID: 18988913 DOI: 10.1161/strokeaha.108.520866] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We report our experience using Matrix coils in coiling of cerebral aneurysms. METHODS Clinical and angiographic outcomes of 152 patients (165 aneurysms) treated exclusively with Matrix coils were retrospectively analyzed. RESULTS There were 74 ruptured aneurysms (44.8%) and 91 unruptured (55.2%). After coiling, 84 (50.9%) aneurysms were occluded, 38 (23.0%) aneurysms had a neck remnant, and 43 (26.1%) aneurysms had a sac remnant. Packing ranged from 10% to 49% (mean and median, 27%). Overall treatment-induced morbidity was 6.6% and mortality was 1.3% (10 of 152 to 2 of 152, respectively). One hundred fifteen (69.7%) aneurysms were followed, disclosing 42 (36.5%) recurrences at a mean period of 9 months (median, 6 months; range, 1 to 28 months). The recurrence rate for small aneurysms (<10 mm) was 28 (31.1%) of 90, whereas for larger aneurysms (>/=10 mm), the recurrence rate was 14 (56.0%) of 25 (P=0.0336). When packing was </=25%, the recurrence rate was 44.4%, whereas for aneurysms with packing >25%, the recurrence rate was 29.8% (P=0.1588). Recurrence rate was not correlated to packing. Ruptured aneurysms recurred more frequently than unruptured aneurysms (P=0.0004). CONCLUSIONS Matrix coils provided no better recanalization rates than those reported previously for bare platinum coils.
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White PM, Raymond J. Endovascular coiling of cerebral aneurysms using "bioactive" or coated-coil technologies: a systematic review of the literature. AJNR Am J Neuroradiol 2008; 30:219-26. [PMID: 18842754 DOI: 10.3174/ajnr.a1324] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY Second-generation coils have been available since 2002. We wanted to assess their performance and appraise available evidence. Therefore we performed a systematic review of the literature from 2002 to 2007. There were 27 studies with a total of 2390 patients that met pre-specified inclusion criteria. All studies were classed as having a high risk of bias. There were no randomized trials and for most studies results were not independently assessed and follow-up periods were short (mean 7 months). There were large differences in demographic and aneurysm characteristics, making comparisons between coil cohorts difficult. Procedure-related morbidity and mortality were similar for all coil types. Hemorrhagic events during follow-up were few, in the range of 1%/year for all coil types. The available literature is of poor quality and clinical series provide very little evidence in favor of second-generation coils. Positive randomized trial results are needed to justify routine clinical use. This systematic review illustrates the failure of the industry, the regulatory authorities, and the neurointerventional community combined to provide a reliable and prudent approach to the introduction of new devices.
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Affiliation(s)
- P M White
- International Consortium of Neuroendovascular Centres, Interventional Neuroradiology Research Unit, Department of Radiology, University of Montreal, CHUM Notre-Dame Hospital, Montreal, Canada.
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Kurre W, Berkefeld J. Materials and techniques for coiling of cerebral aneurysms: how much scientific evidence do we have? Neuroradiology 2008; 50:909-27. [PMID: 18802691 DOI: 10.1007/s00234-008-0446-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 08/07/2008] [Indexed: 11/30/2022]
Affiliation(s)
- W Kurre
- Department of Neuroradiology, University of Frankfurt, Frankfurt, Germany.
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Hopkins LN, Ecker RD. CEREBRAL ENDOVASCULAR NEUROSURGERY. Neurosurgery 2008; 62:SHC1483-SHC1502. [DOI: 10.1227/01.neu.0000315304.66122.f0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Accepted: 03/05/2008] [Indexed: 11/19/2022] Open
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Roth C, Struffert T, Grunwald IQ, Romeike BFM, Krick C, Papanagiotou P, Krampe P, Reith W. Long-term results with Matrix coils vs. GDC: an angiographic and histopathological comparison. Neuroradiology 2008; 50:693-9. [PMID: 18509628 DOI: 10.1007/s00234-008-0392-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2007] [Accepted: 03/25/2008] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The aim of the study was to compare standard platinum Guglielmi detachable coils (GDC) with coated platinum coils (Matrix; both Boston Scientific, Fremont, CA) regarding handling, complications, occlusion and recanalization rate after 3 and 6A months. METHODS Aneurysms in the right common carotid artery were created in 25 rabbits. The animals were divided into five groups of five animals each. The animals of group 1 (the control group) received no treatment of the induced aneurysms, the animals of groups 2 and 3 (killed at 3 and 6A months) were treated with standard GDC, and the animals of groups 4 and 5 (killed at 3 and 6A months) were treated with Matrix coils. RESULTS Histopathological evaluation showed organized thrombus formation and connective tissue with neovascularization around the implanted coils in all the treated groups. The achieved occlusion rates in groups 2 and 3 were identical to those in groups 4 and 5. Thus the long-term results of aneurysm treatment with GDC and Matrix coils show no differences regarding occlusion and recanalization rates. The only noticeable difference was the difference in handling. More force was required to pushing the Matrix coils forward through the microcatheter and there was more friction in coil interaction in the aneurysm. CONCLUSION The bioactive coating of the Matrix coil produces no significant benefit in achieving higher occlusion and lower recanalization rates, and the coil is more difficult to handle. Future bioactive coils must be shown to produce significantly better long-term results than GDC and their ease of handling has to be improved.
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Affiliation(s)
- C Roth
- Department of Diagnostic and Interventional Neuroradiology, University of the Saarland, Homburg, Germany.
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Pierot L, Leclerc X, Bonafé A, Bracard S. Endovascular treatment of intracranial aneurysms with matrix detachable coils: midterm anatomic follow-up from a prospective multicenter registry. AJNR Am J Neuroradiol 2007; 29:57-61. [PMID: 17921229 DOI: 10.3174/ajnr.a0738] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Polyglycolic/polylactic acid-covered platinum coils have been proposed to reduce the rate of aneurysm recanalization after endovascular treatment. A prospective and multicenter registry was conducted in France to evaluate the safety and short-term and midterm efficacy of Matrix coils. This analysis focused on anatomic midterm results. MATERIALS AND METHODS Two hundred thirty-six patients harboring 244 ruptured or unruptured aneurysms treated via endovascular approach by using Matrix coils were included in this registry. Treatment was totally or partially performed by using Matrix coils. Anatomic results were evaluated on postoperative and last-follow-up digital subtraction angiography (DSA) by using the Raymond scale. "Recanalization" was defined as worsening, and "progressive thrombosis" was defined as improvement on the Raymond scale. RESULTS Anatomic midterm follow-up was obtained in 165 of 236 patients (70%) harboring 171 aneurysms (range, 6-27 months; mean, 14 +/- 4 months). At midterm follow-up angiography, 79 aneurysms were completely occluded (46.2%), 43 had a neck remnant (25.1%), and 49 had an aneurysm remnant (28.7%). Of 171 aneurysms, recanalization was observed in 44 patients (25.7%), including major recanalization in 18 patients (10.5%). Recanalization was more frequent if the embolized volume of aneurysm was </=25%. Progressive thrombosis was observed in 52 aneurysms (30%). No bleeding or rebleeding was observed during the period of follow-up. CONCLUSION The efficacy of Matrix coils in preventing recanalization was not demonstrated in our series. In agreement with previous studies using bare platinum coils, volumic occlusion was an important feature for the prediction of aneurysm recanalization. A high percentage of progressive thrombosis in incompletely treated aneurysms was observed in our series, suggesting a biologic activity of Matrix coils.
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Affiliation(s)
- L Pierot
- Department of Neuroradiology, Reims University, Reims, France.
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Turk AS, Luty CM, Carr-Brendel V, Polyakov I, Consigny D, Grinde J, Mukherjee R, Strother CM. Angiographic and histological comparison of canine bifurcation aneurysms treated with first generation matrix and standard GDC coils. Neuroradiology 2007; 50:57-65. [PMID: 17899048 DOI: 10.1007/s00234-007-0302-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 08/10/2007] [Indexed: 11/30/2022]
Abstract
INTRODUCTION It is claimed that bioactive coils induce accelerated and more durable aneurysm healing. Data supporting this claim are quite limited. Our purpose was to compare the angiographic and histological results obtained following treatment with different coil types. METHODS Bifurcation type aneurysms were surgically created in 24 dogs and treated using standard clinical techniques. Eight were treated with Guglielmi detachable coils (GDC), eight with first-generation Matrix coils, and eight with a combination of GDC and Matrix coils. The aneurysms were explanted and final angiographic evaluations performed 12 weeks after treatment. Angiographic and histological outcomes were documented. RESULTS Increased coil compaction with aneurysm recurrence was found in aneurysms treated with first-generation Matrix coils as compared to standard GDC (P = 0.0001). In aneurysms treated with first-generation Matrix coils thrombus organization was better than in those treated with either standard GDC coils (P = 0.008) or with a combination of GDC and Matrix coils (P = 0.04). In aneurysms treated with first-generation Matrix coils there were no endothelialized vascular clefts within the coil mass, but they were seen in the majority of aneurysms treated with GDC or a combination of GDC and Matrix coils (P = 0.003). CONCLUSION Aneurysms treated with first-generation Matrix coils showed the greatest degree of coil compaction and aneurysm recurrence on the final angiographic evaluation. Aneurysms treated with first-generation Matrix coils showed enhanced thrombus organization and absence of vascular clefts at the aneurysm neck that were markedly different from those treated with bare platinum coils or a combination of GDC and Matrix coils.
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Affiliation(s)
- Aquilla S Turk
- Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
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Turk AS, Luty CM, Grum K, Grinde J, Consigny D, Pulfer K, Rappe A, Strother CM. Comparison of platinum and first-generation Matrix coils in under-packed canine side-wall aneurysms: evaluation of progressive thrombosis. Neuroradiology 2007; 49:939-45. [PMID: 17701406 DOI: 10.1007/s00234-007-0280-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 07/01/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION There is much speculation in reference to the occurrence and mechanisms of progressive aneurysm occlusion after treatment with bioactive coils. However, to our knowledge, there are no studies documenting the impact on progressive occlusion in aneurysms that are intentionally under-packed. METHODS A total of 24 experimental side-wall aneurysms were created in canine common carotid arteries. Of these 24, 9 were treated with Guglielmi detachable coils (GDC) and 15 with first-generation Matrix (Matrix1) coils to packing densities of 22% or less. Angiograms were obtained immediately after treatment and again at the time of explant at 2 weeks, 8 weeks, or 12 weeks, and were graded utilizing the Raymond scale. At the time of the final angiography and explant all aneurysms were histologically processed and evaluated. RESULTS At the conclusion of initial coiling, near or complete occlusion was achieved in 7 of the 15 aneurysms (47%) treated with Matrix1 coils and in 2 of the 9 (22%) treated with GDC. Of the aneurysms that were incompletely occluded, six of eight (75%) treated with Matrix1 coils and two of seven (29%) treated with GDC showed progressive thrombosis at explant. Histopathological analysis demonstrated that the aneurysms treated with Matrix1 coils had increased fibrocellular tissue and inflammation, with less histological recanalization or vascular spaces, relative to those treated with GDC. CONCLUSION Experimental wide-necked side-wall canine aneurysms suboptimally treated with first-generation Matrix1 coils had a higher incidence of progressive occlusion and on histological analysis showed evidence of more advanced thrombus organization than did those treated with GDC.
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Affiliation(s)
- Aquilla S Turk
- Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., Madison, WI, 53792, USA.
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Yuki I, Lee D, Murayama Y, Chiang A, Vinters HV, Nismmura I, Wang CJ, Ishii A, Wu BM, Viñuela F. Thrombus organization and healing in an experimental aneurysm model. Part II. The effect of various types of bioactive bioabsorbable polymeric coils. J Neurosurg 2007; 107:109-20. [PMID: 17639880 DOI: 10.3171/jns-07/07/0109] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Bioabsorbable polymeric material coils are being used in the endovascular treatment of aneurysms to achieve better thrombus organization than is possible using bare platinum coils. We used immunohistochemical and molecular biological analysis techniques in experimental aneurysms implanted with three different bioabsorbable polymer coils and platinum coils. METHODS The degradation kinetics of nine polymer candidates for further analysis were first analyzed in vitro, and three materials with different degradation rates were selected. Seventy-four aneurysms were created in 37 swine using the venous pouch technique. The aneurysms were surgically implanted with one of the materials as follows (time points = 3, 7, and 14 days): Group 1, Guglielmi detachable coils (platinum); Group 2, Polysorb (90:10 polyglycolic acid [PGA]/polylactic acid); Group 3, Maxon (PGA/trimethylene carbonate); and Group 4, poly-l-lactic acid. Histological, immunohistochemical, and cDNA microarray analyses were performed on tissue specimens. RESULTS Groups 1 and 4 showed minimal inflammatory response adjacent to the coil mass. In Group 2, Polysorb elicited a unique, firm granulation tissue that accelerated intraaneurysmal thrombus organization. In Group 3 intermediate inflammatory reactions were seen. Microarray analysis with Expression Analysis Sytematic Explorer software showed functional-cluster-gene activation to be increased at Day 7, preceding the histologic manifestation of polymer-induced granulation tissue at Day 14. A profile of expression changes in cytokine-related and extracellular membrane-related genes was compiled. CONCLUSIONS Degradation speed was not the only factor determining the strength of the biological response. Polysorb induced an early, unique granulation tissue that conferred greater mechanical strength to the intraaneurysmal coilthrombus complex. Enhancing the formation of this polymer-induced granulation tissue may provide a new direction for improving long-term anatomical outcomes in cases involving aneurysms embolized with detachable coils.
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Affiliation(s)
- Ichiro Yuki
- Division of Interventional Neuroradiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, California 90095-1721, USA.
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