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1
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Liang D. Endovascular treatment of intracranial aneurysms: Past and present. J Cerebrovasc Endovasc Neurosurg 2024; 26:249-259. [PMID: 38247034 PMCID: PMC11449534 DOI: 10.7461/jcen.2024.e2023.09.005] [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: 09/21/2023] [Revised: 11/07/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Intracranial aneurysm is common in stroke and, once rupturing, will cause disaster to patients. Nowadays, endovascular treatment has become a routine to reduce the risk of intracranial aneurysms rupture. Successive endovascular methods, like balloon-assisted coiling, stent-assisted coiling, and flow diversion, have become new choices for doctors. More and more doctors have been entering this field. Understanding the current general situation is crucial for more medical workers to learn the endovascular treatment of intracranial aneurysms. In the past, many devices and ideas about the treatment of intracranial aneurysms appeared. Although developing unceasingly, endovascular treatment still has some deficiencies to overcome. The advantages and drawbacks of current endovascular methods are discussed.
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Affiliation(s)
- Dongming Liang
- Department of Neurosurgery, Sun Yet-sen Memorial Hospital, Guangzhou, China
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2
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Beal T, Say C, Ghasemi Rad M, Leon D. A Novel Microsnare and Microwire Coil Retrieval Technique. Vasc Endovascular Surg 2024; 58:567-570. [PMID: 38240584 DOI: 10.1177/15385744241229599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
Coil migration during endovascular embolization is a complication that can result in thromboembolic occlusion leading to potentially large infarcts if not removed. Microsnares are commonly used to remove migrated coils. Current techniques, however, struggle in cases where the microsnare is unable to loop over and secure a free end of the coil. We present a case in which a microsnare combined with a microwire successfully removed a migrated coil in a patient with a bleeding hepatic pseudoaneurysm post-embolization. This technique proved beneficial when traditional methods were insufficient, especially in small vessels or coil packs that cannot be snared. The synergy of the microsnare and microwire technique presents a promising solution for challenging migrated coil retrievals.
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Affiliation(s)
- Taylor Beal
- Department of Student Affairs, Baylor College of Medicine, Houston, TX, USA
| | - Conrad Say
- Department of Student Affairs, Baylor College of Medicine, Houston, TX, USA
| | | | - David Leon
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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3
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Łajczak PM, Jurek B, Jóźwik K, Nawrat Z. Bridging the gap: robotic applications in cerebral aneurysms neurointerventions - a systematic review. Neurosurg Rev 2024; 47:150. [PMID: 38600417 PMCID: PMC11006626 DOI: 10.1007/s10143-024-02400-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 04/12/2024]
Abstract
Cerebral aneurysm is a life-threatening condition, which requires high precision during the neurosurgical procedures. Increasing progress of evaluating modern devices in medicine have led to common usage of robotic systems in many fields, including cranial aneurysm operations. However, currently no systematic review describes up-to date knowledge of this topic. Following PRISMA guidelines, we have independently screened and extracted works from seven databases. Only studies fulfilling inclusion criteria were presented in this study. Device used, operation time, complications, aneurysm type and patient demographics were extracted from each work. We identified a total of 995 articles from databases. We have found six original works and one supplementary article eligible for this synthesis. Majority of works (4/6) have implemented CorPath GRX in cerebral aneurysm procedures. The procedures involved diverse aneurysm locations, utilizing flow diverters, stents, or coiling. One study described implementation of robot-assist on 117 patients and compared results to randomized clinical trials. One work with a small patient cohort described use of the magnetically-controlled microguidewire in the coiling procedures, without any complications. Additionally, one case-series study described use of a robotic arm for managing intraoperative aneurysm rupture. Currently, robotical devices for cerebral aneurysm treatment mainly lack jailing and haptic feedback feature. Further development of these devices will certainly be beneficial for operators and patients, allowing for more precise and remote surgeries.
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Affiliation(s)
- Paweł Marek Łajczak
- Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 18, Zabrze, 40-043, Poland.
| | - Bartłomiej Jurek
- Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 18, Zabrze, 40-043, Poland
| | - Kamil Jóźwik
- Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 18, Zabrze, 40-043, Poland
| | - Zbigniew Nawrat
- 2Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 18, Zabrze, 40-043, Poland
- 3Foundation of Cardiac Surgery Development, Zabrze, 41-808, Poland
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4
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Mendes Pereira V, Rice H, De Villiers L, Sourour N, Clarencon F, Spears J, Tomasello A, Hernandez D, Cancelliere NM, Liu XYE, Nicholson P, Costalat V, Gascou G, Mordasini P, Gralla J, Martínez-Galdámez M, Galvan Fernandez J, Killer-Oberpfalzer M, Liebeskind DS, Turner RD, Blanc R, Piotin M. Evaluation of effectiveness and safety of the CorPath GRX robotic system in endovascular embolization procedures of cerebral aneurysms. J Neurointerv Surg 2024; 16:405-411. [PMID: 37793795 PMCID: PMC10958306 DOI: 10.1136/jnis-2023-020161] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/07/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Robotic-assisted neurointervention was recently introduced, with implications that it could be used to treat neurovascular diseases. OBJECTIVE To evaluate the effectiveness and safety of the robotic-assisted platform CorPath GRX for treating cerebral aneurysms. METHODS This prospective, international, multicenter study enrolled patients with brain aneurysms that required endovascular coiling and/or stent-assisted coiling. The primary effectiveness endpoint was defined as successful completion of the robotic-assisted endovascular procedure without any unplanned conversion to manual treatment with guidewire or microcatheter navigation, embolization coil(s) or intracranial stent(s) deployment, or an inability to navigate vessel anatomy. The primary safety endpoint included intraprocedural and periprocedural events. RESULTS The study enrolled 117 patients (74.4% female) with mean age of 56.6 years from 10 international sites,. Headache was the most common presenting symptom in 40/117 (34.2%) subjects. Internal carotid artery was the most common location (34/122, 27.9%), and the mean aneurysm height and neck width were 5.7±2.6 mm and 3.5±1.4 mm, respectively. The overall procedure time was 117.3±47.3 min with 59.4±32.6 min robotic procedure time. Primary effectiveness was achieved in 110/117 (94%) subjects with seven subjects requiring conversion to manual for procedure completion. Only four primary safety events were recorded with two intraprocedural aneurysm ruptures and two strokes. A Raymond-Roy Classification Scale score of 1 was achieved in 71/110 (64.5%) subjects, and all subjects were discharged with a modified Rankin Scale score of ≤2. CONCLUSIONS This first-of-its-kind robotic-assisted neurovascular trial demonstrates the effectiveness and safety of the CorPath GRX System for endovascular embolization of cerebral aneurysm procedures. TRIAL REGISTRATION NUMBER NCT04236856.
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Affiliation(s)
- Vitor Mendes Pereira
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Hal Rice
- Department of Neurointervention, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Laetitia De Villiers
- Department of Neurointervention, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Nader Sourour
- Department of Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Frédéric Clarencon
- Department of Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Julian Spears
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Alejandro Tomasello
- Department of Neurointervention, Hospital Vall d'Hebron, Barcelona, Catalunya, Spain
| | - David Hernandez
- Department of Neurointervention, Hospital Vall d'Hebron, Barcelona, Catalunya, Spain
| | - Nicole M Cancelliere
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Xiao Yu Eileen Liu
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Nicholson
- Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vincent Costalat
- Department of Neuroradiology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Pasquale Mordasini
- Department of Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Jan Gralla
- Department of Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Mario Martínez-Galdámez
- Department of Interventional Neuroradiology and Endovascular Neurosurgery, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Jorge Galvan Fernandez
- Department of Interventional Neuroradiology and Endovascular Neurosurgery, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Raymond D Turner
- Division of Neurosurgery, Prisma Health, Greenville, South Carolina, USA
| | - Raphael Blanc
- Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France
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Nasra M, Maingard JT, Hall J, Mitreski G, Kuan Kok H, Smith PD, Russell JH, Jhamb A, Brooks DM, Asadi H. Clipping versus coiling: A critical re-examination of a decades old controversy. Interv Neuroradiol 2024; 30:86-93. [PMID: 36017537 PMCID: PMC10956463 DOI: 10.1177/15910199221122854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Two major studies, The International Subarachnoid Aneurysm Trial and the Barrow Ruptured Aneurysm Trial, compare the long-term outcomes of clipping and coiling. Although these demonstrated coiling's initial benefits, rebleeding and retreatment rates as well as converging patient outcomes sparked controversy regarding its durability. This article will critically examine the available evidence for and against clipping and coiling of intracranial aneurysms. Critics of endovascular treatment state that the initial benefit seen with endovascular coiling decreases over the duration of follow-up and eventually functional outcomes of both treatment modalities are similar. Combined with the increased rate of retreatment and rebleeding, these trials reveal that coiling is not as durable and not as effective as a long-term treatment compared to clipping. Also, due to the cost of devices following endovascular treatment and prolonged hospitalization following clipping, the financial burden has been considered controversial. SUMMARY/KEY MESSAGES Short-term outcomes reveal better morbidity and mortality outcomes following coiling. Despite the higher rates of retreatment and rebleeding with coiling, there was no significant change in functional outcomes following retreatment. Furthermore, examining more recent trials reveals a decreased rate of recurrence and rebleeding with improved technology and expertise. Functional outcomes deteriorate for both cohorts over time while recent results revealed improved long-term cognitive outcomes and levels of health-related quality of life after coiling in comparison to clipping. The expense of longer hospital stays following clipping must be balanced against the expense of endovascular devices in coiling.
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Affiliation(s)
| | - Julian Tam Maingard
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia
- Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia
| | - Jonathan Hall
- Department of Interventional Radiology, St Vincent's Health Australia, Fitzroy, Victoria, Australia
| | - Goran Mitreski
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia
| | - Hong Kuan Kok
- Interventional Radiology Service, Northern Hospital, Epping, Victoria, Australia
| | - Paul D. Smith
- Department of Neurosurgery, St Vincent's Hospital, Fitzroy, Victoria, Melbourne, Australia
- Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Jeremy H. Russell
- Department of Neurosurgery, Austin Health, Heidelberg, Victoria, Australia
| | - Ashu Jhamb
- Department of Interventional Radiology, St Vincent's Health Australia, Fitzroy, Victoria, Australia
| | - Duncan Mark Brooks
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia
- School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia
| | - Hamed Asadi
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia
- School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
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6
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Ho Shim J, Park JH, Yong Yun G, Ahn JM, Oh HJ, Shim JJ, Mann Yoon S. Strategy of stretched Coils: Insights from a single center experience. J Clin Neurosci 2024; 120:204-212. [PMID: 38281474 DOI: 10.1016/j.jocn.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE A stretched coil, characterized by excessive elongation within the parent artery during a coil embolization procedure, poses a significant risk of forming a thrombus. This study reports on cases of stretched coils spanning 16 years and discusses effective assessment methods and treatment strategies. METHOD Retrospective analysis of the institutional database comprising 14 cases where stretched coils were observed during coil embolization procedures was conducted, starting from January 2007. RESULTS Among the 14 cases, four involved coil embolization for subarachnoid hemorrhage due to ruptured aneurysm, while the remaining cases were unruptured aneurysms. Starting in 2017, vaso-computed tomography (vaso-CT) was employed in nine cases to evaluate the proximal end of the stretched coils. Reimplantation was performed in 3 cases. Among them, two cases were relieved by pushing the coil delivery wire or microwire, while one case underwent balloon-assisted reimplantation. The stretched coils were removed in three cases by pulling. A rescue gooseneck microsnare technique was applied in one case. The stent was fixed in five cases. In two cases, no additional procedures were performed. Thrombosis is a potential complication that occurred in three cases of stretched coils. CONCLUSION Many studies have addressed coil stretching and introduced various rescue methods, but relying solely on angiography for diagnosis or applying an inappropriate rescue technique can lead to ischemic stroke. This study emphasized the importance of vaso-CT as a tool for accurately identifying the proximal end of a stretched coil. Additionally, we aimed to facilitate the selection of an appropriate rescue technique.
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Affiliation(s)
- Jun Ho Shim
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jong-Hyun Park
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea.
| | - Gi Yong Yun
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jae-Min Ahn
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hyuk-Jin Oh
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jai-Joon Shim
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Seok Mann Yoon
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
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Frandon J, Loffroy R, Marcelin C, Vernhet-Kovacsik H, Greffier J, Dabli D, Sammoud S, Marek P, Chevallier O, Beregi JP, Rousseau H. Safety and Efficacy of Prestige Coils for Embolization of Vascular Abnormalities: The Embo-Prestige Study. J Pers Med 2023; 13:1464. [PMID: 37888075 PMCID: PMC10608704 DOI: 10.3390/jpm13101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 10/28/2023] Open
Abstract
A wide variety of coils are available for vascular embolization. This study aimed to evaluate the safety and efficacy of a new Prestige coil. We carried out retrospective analysis of a multicenter's registry data collected between February 2022 and November 2022. The choice of embolization agent used to treat peripheral vascular anomalies was left to the investigator's discretion. Patients for whom at least one Prestige coil was used were included in Series 1. All other patients were included in Series 2. Efficacy and safety were evaluated. Patients were followed up for one month. In total, 220 patients were included, 110 in each series. Patients included 149 men (67.7%) and 71 women (32.3%), with a median age of 62.5 years (IQR: 35.8-73). Patient ages were similar in the two series. Complete occlusion of the targeted vessel was reported in 96.4% (n = 106/110) of patients in Series 1 and in 99.7% (n = 109/110) in Series 2. Four patients experienced non-serious adverse events (1.8%, n = 4/220): one experienced back pain and one vomiting in Series 1; one patient had off-target embolization and one a puncture site hematoma in Series 2. Sixteen patients (7.2%, n = 16/220) were lost to follow up. Improvement in the patient's general state at one month was reported in 79.0% (n = 83/105) of patients in Series 1 and in 74.7% (n = 74/99) in Series 2. Ten deaths occurred, five in Series 1 (4.8%, n = 5/105) and five in Series 2 (5.1%, n = 5/99). These deaths all concerned critically ill patients embolized for emergent arterial bleeding. In conclusion, the 1-month follow-up showed that Prestige coils, alone or in combination, are efficient and safe.
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Affiliation(s)
- Julien Frandon
- Department of Medical Imaging, IPI Plateform, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France; (J.G.); (D.D.); (S.S.); (J.-P.B.)
| | - Romaric Loffroy
- Department of Radiology, CHU Dijon-Bourgogne, 21079 Dijon, France; (R.L.); (O.C.)
| | - Clement Marcelin
- Centre Hospitalier Universitaire de Bordeaux, Service d’Imagerie Diagnostique et Thérapeutique de l’Adulte, Hopital Pellegrin, 33076 Bordeaux, France;
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, Université Bordeaux, 33076 Bordeaux, France
| | - Hélène Vernhet-Kovacsik
- Department of Radiology, CHU of Montpellier, Arnaud de Villeneuve Hospital, 34090 Montpellier, France;
| | - Joel Greffier
- Department of Medical Imaging, IPI Plateform, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France; (J.G.); (D.D.); (S.S.); (J.-P.B.)
| | - Djamel Dabli
- Department of Medical Imaging, IPI Plateform, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France; (J.G.); (D.D.); (S.S.); (J.-P.B.)
| | - Skander Sammoud
- Department of Medical Imaging, IPI Plateform, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France; (J.G.); (D.D.); (S.S.); (J.-P.B.)
| | - Pierre Marek
- Interventional Radiology Department, Rangueil Hospital, University Hospital of Toulouse, 31400 Toulouse, France; (P.M.); (H.R.)
| | - Olivier Chevallier
- Department of Radiology, CHU Dijon-Bourgogne, 21079 Dijon, France; (R.L.); (O.C.)
| | - Jean-Paul Beregi
- Department of Medical Imaging, IPI Plateform, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, IMAGINE, 30029 Nîmes, France; (J.G.); (D.D.); (S.S.); (J.-P.B.)
| | - Hervé Rousseau
- Interventional Radiology Department, Rangueil Hospital, University Hospital of Toulouse, 31400 Toulouse, France; (P.M.); (H.R.)
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Volovici V, Verploegh IS, Satoer D, Vrancken Peeters NJMC, Sadigh Y, Vergouwen MDI, Schouten JW, Bruggeman G, Pisica D, Yildirim G, Cozar A, Muller F, Zidaru AM, Gori K, Tzourmpaki N, Schnell E, Thioub M, Kicielinski K, van Doormaal PJ, Velinov N, Boutarbouch M, Lawton MT, Lanzino G, Amin-Hanjani S, Dammers R, Meling TR. Outcomes Associated With Intracranial Aneurysm Treatments Reported as Safe, Effective, or Durable: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2331798. [PMID: 37656458 PMCID: PMC10474558 DOI: 10.1001/jamanetworkopen.2023.31798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
Importance Testing new medical devices or procedures in terms of safety, effectiveness, and durability should follow the strictest methodological rigor before implementation. Objectives To review and analyze studies investigating devices and procedures used in intracranial aneurysm (IA) treatment for methods and completeness of reporting and to compare the results of studies with positive, uncertain, and negative conclusions. Data Sources Embase, MEDLINE, Web of Science, and The Cochrane Central Register of Clinical Trials were searched for studies on IA treatment published between January 1, 1995, and the October 1, 2022. Grey literature was retrieved from Google Scholar. Study Selection All studies making any kind of claims of safety, effectiveness, or durability in the field of IA treatment were included. Data Extraction and Synthesis Using a predefined data dictionary and analysis plan, variables ranging from patient and aneurysm characteristics to the results of treatment were extracted, as were details pertaining to study methods and completeness of reporting. Extraction was performed by 10 independent reviewers. A blinded academic neuro-linguist without involvement in IA research evaluated the conclusion of each study as either positive, uncertain, or negative. The study followed Preferring Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Main Outcomes and Measures The incidence of domain-specific outcomes between studies with positive, uncertain, or negative conclusions regarding safety, effectiveness, or durability were compared. The number of studies that provided a definition of safety, effectiveness, or durability and the incidence of incomplete reporting of domain-specific outcomes were evaluated. Results Overall, 12 954 studies were screened, and 1356 studies were included, comprising a total of 410 993 treated patients. There was no difference in the proportion of patients with poor outcome or in-hospital mortality between studies claiming a technique was safe, uncertain, or not safe. Similarly, there was no difference in the proportion of IAs completely occluded at last follow-up between studies claiming a technique was effective, uncertain, or noneffective. Less than 2% of studies provided any definition of safety, effectiveness, or durability, and only 1 of the 1356 studies provided a threshold under which the technique would be considered unsafe. Incomplete reporting was found in 546 reports (40%). Conclusions and Relevance In this systematic review and meta-analysis of IA treatment literature, studies claiming safety, effectiveness, or durability of IA treatment had methodological flaws and incomplete reporting of relevant outcomes supporting these claims.
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Affiliation(s)
- Victor Volovici
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Iris S. Verploegh
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Djaina Satoer
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | | | - Yasmin Sadigh
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Mervyn D. I. Vergouwen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Joost W. Schouten
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Gavin Bruggeman
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Dana Pisica
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
- Centre for Medical Decision Science, Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Gizem Yildirim
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Ayca Cozar
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Femke Muller
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Ana-Maria Zidaru
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Kelsey Gori
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Nefeli Tzourmpaki
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Esther Schnell
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Mbaye Thioub
- Department of Neurosurgery, CHNU Fann, University Cheikh Anta Diop, Dakar, Senegal
| | | | - Pieter-Jan van Doormaal
- Department of Interventional Radiology, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Nikolay Velinov
- Department of Neurosurgery, University Hospital Pirogov, Medical University of Sofia, Sofia, Bulgaria
| | - Mahjouba Boutarbouch
- Department of Neurosurgery, Hopital des Specialites, University Mohammed V, Rabat, Morrocco
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Giuseppe Lanzino
- Department of Neurosurgery and Interventional Neuroradiology, Mayo Clinic, Rochester, Minnesota
| | | | - Ruben Dammers
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
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9
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Kulhari A, Fourcand F, Singh A, Zacharatos H, Mehta S, Kirmani JF. Retrieval of Migrated Coils From Distal Cerebral Vasculature Using Stent Retriever: A Case Series. Cureus 2023; 15:e37213. [PMID: 37159773 PMCID: PMC10163925 DOI: 10.7759/cureus.37213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 05/11/2023] Open
Abstract
The incidence of coil dislocation during an endovascular embolization of intracranial aneurysm is low but it can lead to serious thrombo-embolic complications. Therefore, coil displacement/migration often requires either retrieval or fixation of the errant coil with a stent. There are no standard recommended methods of coil retrieval. We present a series of three cases in which off-label application of a stent retriever allowed successful retrieval of herniated coils.
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Affiliation(s)
- Ashish Kulhari
- Department of Neurology, Research Medical Center, Kansas City, USA
- Department of Neurology, University of Missouri Kansas City School of Medicine, Kansas City, USA
- Department of Medicine, Kansas City University of Medicine and Biosciences, Kansas City, USA
| | - Farah Fourcand
- Department of Neurology, Hackensack Meridian JFK University Medical Center, Edison, USA
| | - Amrinder Singh
- Department of Neurology, United Health Services (UHS) Binghamton General Hospital, Johnson City, USA
| | - Haralabos Zacharatos
- Department of Neurology, Hackensack Meridian JFK University Medical Center, Edison, USA
| | - Siddhart Mehta
- Department of Neurology, Hackensack Meridian JFK University Medical Center, Edison, USA
| | - Jawad F Kirmani
- Department of Neurology, Hackensack Meridian JFK University Medical Center, Edison, USA
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10
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Muninthorn W, Kobkitsuksakul C, Boongird A. Emergency surgical removal of a migrated coil during embolization of a giant internal carotid artery aneurysm: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22287. [PMID: 36051775 PMCID: PMC9426351 DOI: 10.3171/case22287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/27/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Coil migration during endovascular treatment for an intracranial aneurysm is rare. When it occurs intraoperatively, it often mandates prompt endovascular retrieval or, as a salvage maneuver, microsurgical extraction if it fails endovascularly. OBSERVATIONS The authors presented a case of immediate coil migration during embolization of a giant intracranial cavernous segment of the internal carotid aneurysm. The patient immediately underwent emergency surgical extraction after unsuccessful endovascular retrieval attempts. The migrated coil was successfully removed through the M1 segment of the middle cerebral artery. The patient had full recovery without new neurological deficits. Four years after the incident, she was living independently. Previous case reports of emergency surgical removal of immediate coil migration were provided. LESSONS Surgical extraction of migrated coil after unfeasible endovascular retrieval served as an alternative salvage procedure. Hybrid neurological angiography in the operating suite may prevent unnecessary transfer and provide better real-time visualization of the migrated coil.
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Affiliation(s)
| | - Chai Kobkitsuksakul
- Division of Interventional Neuroradiology, Department of Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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11
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Paul A, MacDonell J, Field N, Entezami P, Yamamoto J, Boulos A, Dalfino J. Comparison of hydrogel coils versus bare platinum coils for the treatment of anterior communicating artery aneurysms. Brain Circ 2022; 8:6-9. [PMID: 35372730 PMCID: PMC8973442 DOI: 10.4103/bc.bc_18_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/21/2021] [Accepted: 10/06/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION: METHODS: RESULTS: CONCLUSIONS:
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12
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6526438. [DOI: 10.1093/ejcts/ezac042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/14/2022] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
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13
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Augustine E, Deng P, Mou C, Okamura M, Woolley B, Horowitz M, Bettinger CJ. Control Release and Diffusion-Reaction Kinetics of Genipin-Eluting Fibers Using an in Vitro Aneurysm Flow Model. ACS Biomater Sci Eng 2021; 7:5144-5153. [PMID: 34597026 DOI: 10.1021/acsbiomaterials.1c00773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The minimally invasive treatment of intracranial aneurysms by endovascular coiling is attractive yet faces challenges related to the degradation of fibrin clots in the aneurysm sac over time. Fibrin gels cross-linked with genipin exhibit enhanced mechanical and chemical stability, but there are many unknowns related to best practices for delivery from endovascular devices and subsequent integration of cross-linkers with the nascent clot. Here, we describe the in vitro characterization of genipin-eluting polymer fibers prepared by coextrusion with poly(ethylene-co-vinyl acetate). Genipin incorporation and release from these fibers are characterized by various gravimetric and spectroscopic techniques. Genipin release adheres to Higuchi kinetics with Higuchi constants varying between (2.44 ± 0.83) × 10-7 and (8.41 ± 0.82) × 10-7 mol·h-0.5 depending on genipin loading and vinyl acetate concentration in the polymer matrix. The diffusion-reaction kinetics of genipin released from polymeric fibers within fibrin hydrogels was investigated using an in vitro aneurysm flow model. Spatiotemporal maps of genipin cross-linking density in fibrin gels produced by absorbance measurements suggest that genipin cross-link concentrations up to 9,993.87 ± 909.01 μM can be achieved. This work describes relevant diffusion-reaction parameters of genipin in fibrin gels and establishes the viability of genipin-eluting fibers as a platform for improving endovascular embolization of intracranial aneurysms.
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Affiliation(s)
- Emily Augustine
- Department of Materials Science and Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, United States
| | - Puqing Deng
- Department of Materials Science and Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, United States
| | - Chenchen Mou
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, United States
| | - Malia Okamura
- Department of Materials Science and Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, United States
| | - Brian Woolley
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, United States.,Department of Chemical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, United States
| | - Michael Horowitz
- First Coast Neurosurgery, 1887 Kingsley Avenue, Suite 1900, Orange Park, Florida 32073, United States
| | - Christopher J Bettinger
- Department of Materials Science and Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, United States.,Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, United States
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14
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Pierot L. Ten Years of Clinical Evaluation of the Woven EndoBridge: A Safe and Effective Treatment for Wide-Neck Bifurcation Aneurysms. Neurointervention 2021; 16:211-221. [PMID: 34674453 PMCID: PMC8561039 DOI: 10.5469/neuroint.2021.00395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
Intrasaccular flow disruption is an innovative approach for the endovascular treatment of intracranial aneurysms. As of now, only one device is currently available worldwide: the Woven EndoBridge (WEB) device (MicroVention, Aliso Viejo, CA, USA). After 10 years of clinical use and careful clinical evaluation of the WEB device by multiple prospective, multicenter studies, this article is summarizing the current knowledge regarding this endovascular technique; indications, modalities, safety and efficacy of the WEB procedure are described.
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Affiliation(s)
- Laurent Pierot
- Department of Neuroradiology, Hôpital Maison-Blanche, CHU Reims, University Reims-Champagne-Ardenne, Reims, France
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15
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Healan SJ, Nicholson G, Doyle T, Janssen D. Percutaneous Hydrogel Coil Embolization of Aneurysms and Coronary Artery Fistulae in Congenital Heart Disease. Tex Heart Inst J 2021; 48:468690. [PMID: 34347100 DOI: 10.14503/thij-20-7312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patients with congenital heart disease frequently have aneurysms or coronary artery fistulae that necessitate treatment. Metal vascular coils have been a mainstay of treatment for these lesions. In 2002, coils coated or filled with expandable hydrogel were introduced to treat cerebral aneurysms; however, the literature on their use in patients with congenital heart disease is limited. We present 5 cases in which large vascular lesions in children or adolescents with congenital heart disease were successfully occluded with hydrogel coils.
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Affiliation(s)
- Steven J Healan
- Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - George Nicholson
- Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas Doyle
- Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dana Janssen
- Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
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16
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Benomar A, Farzin B, Gevry G, Boisseau W, Roy D, Weill A, Iancu D, Guilbert F, Létourneau-Guillon L, Jacquin G, Chaalala C, Bojanowski MW, Labidi M, Fahed R, Volders D, Nguyen TN, Gentric JC, Magro E, Boulouis G, Forestier G, Hak JF, Ghostine JS, Kaderali Z, Shankar JJ, Kotowski M, Darsaut TE, Raymond J. Noninvasive Angiographic Results of Clipped or Coiled Intracranial Aneurysms: An Inter- and Intraobserver Reliability Study. AJNR Am J Neuroradiol 2021; 42:1615-1620. [PMID: 34326106 DOI: 10.3174/ajnr.a7236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/28/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Noninvasive angiography is commonly used to assess the outcome of surgical or endovascular treatment of intracranial aneurysms in clinical series or randomized trials. We sought to assess whether a standardized 3-grade classification system could be reliably used to compare the CTA and MRA results of both treatments. MATERIALS AND METHODS An electronic portfolio composed of CTAs of 30 clipped and MRAs of 30 coiled aneurysms was independently evaluated by 24 raters of diverse experience and training backgrounds. Twenty raters performed a second evaluation 1 month later. Raters were asked which angiographic grade and management decision (retreatment; close or long-term follow-up) would be most appropriate for each case. Agreement was analyzed using the Krippendorff α (αK) statistic, and the relationship between angiographic grade and clinical management choice, using the Fisher exact and Cramer V tests. RESULTS Interrater agreement was substantial (αK = 0.63; 95% CI, 0.55-0.70); results were slightly better for MRA results of coiling (αK = 0.69; 95% CI, 0.56-0.76) than for CTA results of clipping (αK = 0.58; 95% CI, 0.44-0.69). Intrarater agreement was substantial to almost perfect. Interrater agreement regarding clinical management was moderate for both clipped (αK = 0.49; 95% CI, 0.32-0.61) and coiled subgroups (αK = 0.47; 95% CI, 0.34-0.54). The choice of clinical management was strongly associated with the size of the residuum (mean Cramer V = 0.77 [SD, 0.14]), but complete occlusions (grade 1) were followed more closely after coiling than after clipping (P = .01). CONCLUSIONS A standardized 3-grade scale was found to be a reliable and clinically meaningful tool to compare the results of clipping and coiling of aneurysms using CTA or MRA.
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Affiliation(s)
- A Benomar
- From the Department of Radiology (A.B., B.F., G.G., W.B., D.R., A.W., D.I., F.G., L.L.-G., J.R.)
| | - B Farzin
- From the Department of Radiology (A.B., B.F., G.G., W.B., D.R., A.W., D.I., F.G., L.L.-G., J.R.)
| | - G Gevry
- From the Department of Radiology (A.B., B.F., G.G., W.B., D.R., A.W., D.I., F.G., L.L.-G., J.R.)
| | - W Boisseau
- From the Department of Radiology (A.B., B.F., G.G., W.B., D.R., A.W., D.I., F.G., L.L.-G., J.R.)
| | - D Roy
- From the Department of Radiology (A.B., B.F., G.G., W.B., D.R., A.W., D.I., F.G., L.L.-G., J.R.)
| | - A Weill
- From the Department of Radiology (A.B., B.F., G.G., W.B., D.R., A.W., D.I., F.G., L.L.-G., J.R.)
| | - D Iancu
- From the Department of Radiology (A.B., B.F., G.G., W.B., D.R., A.W., D.I., F.G., L.L.-G., J.R.)
| | - F Guilbert
- From the Department of Radiology (A.B., B.F., G.G., W.B., D.R., A.W., D.I., F.G., L.L.-G., J.R.)
| | - L Létourneau-Guillon
- From the Department of Radiology (A.B., B.F., G.G., W.B., D.R., A.W., D.I., F.G., L.L.-G., J.R.)
| | - G Jacquin
- Department of Medicine, Division of Neurology (G.J.)
| | - C Chaalala
- Division of Neurosurgery (C.C., M.W.B., M.L.), Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - M W Bojanowski
- Division of Neurosurgery (C.C., M.W.B., M.L.), Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - M Labidi
- Division of Neurosurgery (C.C., M.W.B., M.L.), Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - R Fahed
- Division ofNeurology (R.F.), The Ottawa Hospital Ottawa, Ontario, Canada
| | - D Volders
- Department of Diagnostic Radiology (D.V.), Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - T N Nguyen
- Departments of Neurology, Neurosurgery, and Radiology (T.N.N.), Boston Medical Center, Boston, Massachusetts
| | - J-C Gentric
- Departments of Interventional Neuroradiology (J.-C.G.)
| | - E Magro
- Neurosurgery (E.M.), Hôpital de la Cavale Blanche, Centre Hospitalier Régional et Universitaire de Brest, Brest, France
| | - G Boulouis
- Department of Neuroradiology (G.B.), Centre Hospitalier Régional et Universitaire de Tours, Tours, France
| | - G Forestier
- Department of Neuroradiology (G.F.), University Hospital of Limoges, Limoges, France
| | - J-F Hak
- Department of Medical Imaging (J.-F.H.), University Hospital Timone Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - J S Ghostine
- Department of Radiology (J.S.G.), Jean-Talon Hospital, Montreal, Quebec, Canada
| | | | - J J Shankar
- Department of Radiology (J.J.S.), Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - M Kotowski
- Department of Neurosurgery (M.K.), Hôpital de la Providence, Neuchâtel, Switzerland
| | - T E Darsaut
- Department of Surgery (T.E.D.), Division of Neurosurgery,Walter C. Mackenzie Health Sciences Centre, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - J Raymond
- From the Department of Radiology (A.B., B.F., G.G., W.B., D.R., A.W., D.I., F.G., L.L.-G., J.R.)
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17
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Ko HC. Rescue balloon-assisted remodeling technique for protrusion of coil loop: A case report. Medicine (Baltimore) 2021; 100:e25783. [PMID: 34106612 PMCID: PMC8133059 DOI: 10.1097/md.0000000000025783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/15/2021] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Among the possible complications during endovascular embolization of intracranial aneurysms, coil protrusion into the parent artery is associated with parent artery occlusion or thromboembolic of the distal arteries. There is no clearly established management strategy for coil protrusion. This report demonstrates our experience with balloon-assisted remodeling to reposition a protruded coil loop. PATIENT CONCERNS A 53-year-old man was admitted to our hospital with severe bursting headache, nausea, and vomiting. Computed tomography showed subarachnoid hemorrhage and digital subtraction angiography revealed an anterior communicating artery aneurysm. We decided to obliterate the aneurysm with endovascular embolization using detachable coils. DIAGNOSIS A small loop protruded into the parent artery during the removal of the microcatheter. INTERVENTIONS We performed successful repositioning of the protruded coil loop using balloon inflation. CONCLUSION The rescue balloon-assisted remodeling technique was useful in the management of protrusion of a small coil loop into the parent artery during endovascular coil embolization of an intracranial aneurysm. The procedure was associated with minimal complications.
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Affiliation(s)
- Hak Cheol Ko
- Department of Neurosurgery, Stroke and Neurological Disorders Centre, Kyung Hee University Hospital at Gangdong
- College of Medicine, Kyung Hee University, Seoul, Korea
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18
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Hongo N, Kiyosue H, Ota S, Nitta N, Koganemaru M, Inoue M, Nakatsuka S, Osuga K, Anai H, Yasumoto T, Tanoue S, Maruno M, Kamei N, Kichikawa K, Abe T, Hasebe T, Asayama Y. Vessel Occlusion using Hydrogel-Coated versus Nonhydrogel Embolization Coils in Peripheral Arterial Applications: A Prospective, Multicenter, Randomized Trial. J Vasc Interv Radiol 2021; 32:602-609.e1. [PMID: 33676799 DOI: 10.1016/j.jvir.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of hydrogel-coated coils for vessel occlusion in the body trunk. MATERIALS AND METHODS A total of 77 patients with various peripheral vascular lesions, treatable by embolization with coils, were randomized (hydrogel group, n = 38; nonhydrogel group, n = 39). In the hydrogel group, embolization of the target vessel was conducted using 0.018-inch hydrogel-coated coils (AZUR 18; Terumo Medical Corporation, Tokyo, Japan) with or without bare platinum coils. The nonhydrogel group received both bare platinum coils and fibered coils without the use of hydrogel-coated coils. RESULTS Complete target vessel occlusion was accomplished in 36 patients in the hydrogel group and 37 patients in the nonhydrogel group. No major adverse events were observed in either group. The median number of coils/vessel diameter and the median total coil length/vessel diameter were significantly larger in the nonhydrogel group than in the hydrogel group (P = .005 and P = .004, respectively). The median embolization length was significantly longer in the nonhydrogel group (31.95 mm) than in the hydrogel group (23.43 mm) (P = .002). If no expansion was assumed, the median packing density in the hydrogel group was 44.9%, which was similar to that in the nonhydrogel group (46.5%) (P = .79). With full expansion assumed, the median packing density in the hydrogel group was 125.7%. CONCLUSIONS Hydrogel-coated coils can be safely used for peripheral vascular coil embolization, and hydrogel-coated and conventional coils in combination allow for a shorter embolization segment and shorter coil length.
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Affiliation(s)
- Norio Hongo
- Department of Radiology, Oita University Faculty of Medicine, Oita, Japan.
| | - Hiro Kiyosue
- Department of Radiology, Oita University Faculty of Medicine, Oita, Japan
| | - Shinichi Ota
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Norihisa Nitta
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | | | - Masanori Inoue
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Seishi Nakatsuka
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Anai
- Department of Radiology, Nara Medical University, Nara, Japan
| | | | - Shuichi Tanoue
- Department of Radiology, Kurume University School of Medicine, Fukuoka, Japan
| | - Miyuki Maruno
- Department of Radiology, Oita University Faculty of Medicine, Oita, Japan
| | - Noritaka Kamei
- Department of Radiology, Oita University Faculty of Medicine, Oita, Japan
| | | | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Fukuoka, Japan
| | - Terumitsu Hasebe
- Department of Radiology/Vascular and Interventional Center, Tokai University Hachioji Hospital, Tokai University School of Medicine, Tokyo, Japan
| | - Yoshiki Asayama
- Department of Radiology, Oita University Faculty of Medicine, Oita, Japan
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19
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Angiographic results of surgical or endovascular treatment of intracranial aneurysms: a systematic review and inter-observer reliability study. Neuroradiology 2021; 63:1511-1519. [PMID: 33625550 DOI: 10.1007/s00234-021-02676-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/15/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Results of surgical or endovascular treatment of intracranial aneurysms are often assessed using angiography. A reliable method to report results irrespective of treatment modality is needed to enable comparisons. Our goals were to systematically review existing classification systems, and to propose a 3-point classification applicable to both treatments and assess its reliability. METHODS We conducted two systematic reviews on classification systems of angiographic results after clipping or coiling to select a simple 3-category scale that could apply to both treatments. We then circulated an electronic portfolio of angiograms of clipped (n=30) or coiled (n=30) aneurysms, and asked raters to evaluate the degree of occlusion using this scale. Raters were also asked to choose an appropriate follow-up management for each patient based on the degree of occlusion. Agreement was assessed using Krippendorff's α statistics (αK), and relationship between occlusion grade and clinical management was analyzed using Fisher's exact and Cramer's V tests. RESULTS The systematic reviews found 70 different grading scales with heterogeneous reliability (kappa values from 0.12 to 1.00). The 60-patient portfolio was independently evaluated by 19 raters of diverse backgrounds (neurosurgery, radiology, and neurology) and experience. There was substantial agreement (αK=0.76, 95%CI, 0.67-0.83) between raters, regardless of background, experience, or treatment used. Intra-rater agreement ranged from moderate to almost perfect. A strong relationship was found between angiographic grades and management decisions (Cramer's V: 0.80±0.12). CONCLUSION A simple 3-point scale demonstrated sufficient reliability to be used in reporting aneurysm treatments or in evaluating treatment results in comparative randomized trials.
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20
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Abstract
Interventional neuroradiology (INR) has evolved from a hybrid mixture of daring radiologists and iconoclastic neurosurgeons into a multidisciplinary specialty, which has become indispensable for cerebrovascular and neurological centers worldwide. This manuscript traces the origins of INR and describes its evolution to the present day. The focus will be on cerebrovascular disorders including aneurysms, stroke, brain arteriovenous malformations, dural arteriovenous fistulae, and atherosclerotic disease, both intra- and extracranial. Also discussed are cerebral vasospasm, venolymphatic malformations of the head and neck, tumor embolization, idiopathic intracranial hypertension, inferior petrosal venous sinus sampling for Cushing's disease, and spinal interventions. Pediatric INR has not been included and deserves a separate, dedicated review.
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21
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Stanzani R, Yamada Y, Kawase T, Devareddy G, Kadam C, Shukurov F, Vaibhav C, Kato Y. Acute Coils Migration Causing Significant M3 Branch Occlusion: A Case Report of Rescue Surgery with Superficial Temporal Artery-Middle Cerebral Artery Bypass. Asian J Neurosurg 2020; 15:428-430. [PMID: 32656147 PMCID: PMC7335151 DOI: 10.4103/ajns.ajns_349_19] [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: 12/02/2019] [Revised: 01/03/2020] [Accepted: 04/09/2020] [Indexed: 11/17/2022] Open
Abstract
We describe an uncommon case of acute coils migration with significant occlusion of M3 branch and our management of this complication. Ballon-assisted coil placement was performed for an unruptured intracavernous internal carotid artery aneurysm in a 62-year-old woman. After coil placement and balloon deflection, we observed coils migration with significant occlusion of M3 branch. After early clinical deterioration without other neurological symptoms, we decided to perform superficial temporal artery-middle cerebral artery (STA-MCA) bypass to ensure blood flow distal to the occlusion. The patient was discharged without neurological deficit. To the best of our knowledge, this is the first case report about STA-MCA bypass to treat acute coils migration. This technique could represent a successful rescue therapy in case of acute coils migration that cannot be retrieved by endovascular tools or in case where distal and deep location of migrated coils controindicate surgical removal.
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Affiliation(s)
- Riccardo Stanzani
- Department of Neurosurgery, Neurosurgery Unit AOU Policlinico di Modena - OCSAE Modena Hospital, Modena, Italy.,Department of Neurosurgery, Neurosurgical Residency Program, University of Padua, Padua, Italy.,Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Yasuhiro Yamada
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Tukasa Kawase
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Gowtham Devareddy
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Chandratej Kadam
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Firuz Shukurov
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Chavan Vaibhav
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan.,Department of Neurosurgery, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
| | - Yoko Kato
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
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22
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Abstract
Vessel occlusion is a frequently used procedure to close congenital or acquired collaterals or communications. We report two cases of successful vessel closure, in small infants with CHD, using the Azur CX Peripheral Coil System. The low profile of the device, the controlled delivery of the coils, and the delivery through a microcatheter make it particularly interesting for the occlusion of highly tortuous vessels in children.
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Pierot L, Barbe C, Nguyen HA, Herbreteau D, Gauvrit JY, Januel AC, Bala F, Comby PO, Desal H, Velasco S, Aggour M, Chabert E, Sedat J, Trystram D, Marnat G, Gallas S, Rodesch G, Clarençon F, Soize S, Gawlitza M, Spelle L, White P. Intraoperative Complications of Endovascular Treatment of Intracranial Aneurysms with Coiling or Balloon-assisted Coiling in a Prospective Multicenter Cohort of 1088 Participants: Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm (ARETA) Study. Radiology 2020; 295:381-389. [DOI: 10.1148/radiol.2020191842] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Embolization using hydrogel-coated coils for pulmonary arteriovenous malformations. Diagn Interv Imaging 2020; 101:129-135. [DOI: 10.1016/j.diii.2019.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/14/2019] [Accepted: 10/22/2019] [Indexed: 11/19/2022]
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Goyal RK, Kato Y, Kawase T, Suzuki K, Yamada Y, Sharma S, Balasubramanian SC, Tanaka R, Miyatani K, Daijiro K. Comparative Outcome Analysis of Enterprise and Neuroform Stent-Assisted Coiling of Cerebral Aneurysms: A Review of the Literature. Asian J Neurosurg 2020; 15:4-9. [PMID: 32181165 PMCID: PMC7057877 DOI: 10.4103/ajns.ajns_284_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/11/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction One of the popular treatment strategies for complex cerebral aneurysms with wide necks or low dome-to-neck ratios is stent-assisted coiling. The most widely used intracranial stents for stent-assisted coiling are Neuroform (NF) and Enterprise (EP) stents. The purposes of this study are to review the recent literature of the past 5 years to compare outcomes between the EP and NF stent-assist coiling systems so as to comment on the safety, efficacy, complications, and recurrence rate of stent-assisted coiling in general. Methods PubMed was used to search for all published literature of NF or EP stent-assisted coiling of unruptured cerebral aneurysms from January 2014 to August 2019 with the search terms of "Enterprise stent-assisted coiling," "Neuroform stent," and "Neuroform vs. Enterprise stent." Results Twenty two publications met the inclusion criteria which encompass 1764 patients and 1873 aneurysms. Out of these 1873 aneurysms, 1007 aneurysms were treated with EP stent and 866 aneurysms were treated with NF stent. The overall outcome was low rates of thromboembolic complications (4.37%) and intracranial hemorrhage (1.13%), low permanent morbidity (1.70%) and mortality (0.40%), and lower rate of recanalization (11%). Data analysis shows an overall higher rate of complication and recurrence of aneurysm and lower overall rate of aneurysmal occlusion in the patients where EP stent was used in comparison to NF stent. However, this difference was not statistically significant. Conclusions The review of two stent-assisted coiling devices using EP and NF stents including 1873 aneurysms in 1764 patients revealed that overall, it is safe and effective with comparable outcomes.
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Affiliation(s)
- Ram Kumar Goyal
- Department of Neurosurgery, GNRC Hospital, Guwahati, Assam, India
| | - Yoko Kato
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Tsukasa Kawase
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Kentaro Suzuki
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Yashuhiro Yamada
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Saurabh Sharma
- Department of Neurosurgery, Max Hospital, New Delhi, India
| | | | - Riki Tanaka
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Kyosuke Miyatani
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Kojima Daijiro
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
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Fahed R, Darsaut TE, Salazkin I, Gevry G, Raymond J. Testing the Medina embolization device in experimental aneurysms. J Neurosurg 2019; 131:1485-1493. [PMID: 30497222 DOI: 10.3171/2018.5.jns18326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/10/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Medina embolization device (MED) is a novel, braided self-expanding endovascular device designed to occlude aneurysms by constructing an in situ intrasaccular flow diverter. Although a single device can be positioned at the neck of simple spherical in vitro aneurysms, the best way to occlude more complex in vivo aneurysms (using multiple MEDs or a combination of MEDs and platinum coils) is currently unknown. METHODS Fifty-two aneurysms of 3 different types were created in 31 canines, yielding 48 patent aneurysms. Treatments were randomly allocated by drawing lots: group 1, MEDs alone (n = 16); group 2, MEDs plus standard platinum coils (n = 16); and group 3, control aneurysms treated with coils alone (n = 16). Angiographic results were scored and compared immediately following treatment completion and at 3 months. Specimens were photographed and the extent of neointimal closure of the aneurysmal neck scored, followed by histopathological analyses. RESULTS Angiographic scores of 0 or 1 (occlusion or near occlusion) were initially obtained in 2 of 16 (12.5%, 95% CI 1.6%-38.3%) group 1 (MEDs alone), 3 of 16 (18.7%, 95% CI 4%-45.6%) group 2 (MEDs plus coils), and 10 of 16 (62.5%, 95% CI 35.4%-84.8%) group 3 (coils alone) aneurysms (p = 0.005). At 3 months, scores of 0 or 1 were found in 11 of 16 (68.7%, 95% CI 41.3%-89.0%) group 1, 9 of 16 (56.2%, 95% CI 29.9%-80.2%) group 2, and 8 of 16 (50%, 95% CI 24.7%-75.3%) group 3 aneurysms (p = 0.82). Neointimal scores were similar for the 3 treated groups (p = 0.66). CONCLUSION Endovascular treatment of experimental aneurysms with MEDs or MEDs and coils showed angiographic occlusion and neointimal scores at 3 months that were similar to those achieved with standard platinum coiling.
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Affiliation(s)
- Robert Fahed
- 1Interventional Neuroradiology Laboratory, Research Centre, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec
| | - Tim E Darsaut
- 2Division of Neurosurgery, Department of Surgery, Mackenzie Health Sciences Centre, University of Alberta Hospital, Edmonton, Alberta; and
| | - Igor Salazkin
- 1Interventional Neuroradiology Laboratory, Research Centre, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec
| | - Guylaine Gevry
- 1Interventional Neuroradiology Laboratory, Research Centre, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec
| | - Jean Raymond
- 1Interventional Neuroradiology Laboratory, Research Centre, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec
- 3Service of Neuroradiology, Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
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Abdalkader M, Piotin M, Chen M, Ortega-Gutierrez S, Samaniego E, Weill A, Norbash AM, Nguyen TN. Coil migration during or after endovascular coiling of cerebral aneurysms. J Neurointerv Surg 2019; 12:505-511. [PMID: 31662464 DOI: 10.1136/neurintsurg-2019-015278] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Coil migration is a complication of endovascular coiling of cerebral aneurysms that has not been well studied. OBJECTIVE To report the frequency, risk factors, management strategies, and outcomes of coil migration. METHODS This was a retrospective analysis of the clinical and radiological data of patients who underwent cerebral aneurysm coiling complicated by coil migration at five neuroendovascular centers in the United States, Canada, and France between 2008 and 2018. RESULTS Eighteen cases of coil migration met our study criteria with an occurrence of 0.3% (18/6071 cases) (procedural migration: 55%, delayed migration: 45%). The mean aneurysm maximal diameter, neck, and height to neck ratio in migration cases were 3.4±1.4 mm (range 2-7.6 mm), 2.4±0.9 mm (range 1.2-4.4 mm), and 1.4±0.4 (range 1-2.15), respectively. The 2 mm diameter coil was the most common (39%, range 1-2.5 mm) migrated coil. The length of the migrated coil was ≤4 cm in 95% of cases.Patients managed conservatively (5/18, 28%) did well. Thromboembolic and/or hemorrhagic complications were noted in 6/10 migration patients treated by endovascular modalities and in all migration patients who underwent surgical treatment (4/4). Three deaths occurred (3/18, 17%) related to high Hunt and Hess grade subarachnoid hemorrhage. CONCLUSION Coil migration is an uncommon but important complication of cerebral aneurysm coiling. Small aneurysms, aspect ratio <1.6, and small coils are significant risk factors. Endovascular treatment, such as using a stent retriever, can be considered for procedural, proximal migration, and/or in cases of vessel occlusion. Delayed or distal migration should be managed conservatively.
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Affiliation(s)
- Mohamad Abdalkader
- Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Michel Piotin
- Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - Michael Chen
- Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Edgar Samaniego
- Neurology, Radiology and Neurosurgery, University of Iowa, Iowa City, Iowa, USA
| | - Alain Weill
- Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | | | - Thanh N Nguyen
- Neurology, Radiology and Neurosurgery, Boston University School of Medicine, Boston, Massachusetts, USA
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Pierot L, Arthur AS, Fiorella D, Spelle L. Intrasaccular Flow Disruption with WEB Device: Current Place and Results in Management of Intracranial Aneurysms. World Neurosurg 2018; 122:313-316. [PMID: 30471439 DOI: 10.1016/j.wneu.2018.11.130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Laurent Pierot
- Department of Neuroradiology, Hospital Maison-Blanche, CHU Reims, University Reims-Champagne-Ardenne, Reims, France
| | - Adam S Arthur
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee, Memphis, Tennessee, USA
| | - David Fiorella
- Department of Neurosurgery, Cerebrovascular Center, State University of New York, Stony Brook, New York, USA
| | - Laurent Spelle
- NEURI Center, Interventional Neuroradiology, Hospital Bicêtre, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
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Marie Y, Kumar A, Hinchliffe S, Curran S, Brown P, Turner D, Shrestha B. Treatment of transplant renal artery pseudoaneurysm using expandable hydrogel coils: A case report and review of literature. World J Transplant 2018; 8:232-236. [PMID: 30370233 PMCID: PMC6201328 DOI: 10.5500/wjt.v8.i6.232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/28/2018] [Accepted: 10/08/2018] [Indexed: 02/05/2023] Open
Abstract
Transplant renal artery (TRA) pseudoaneurysm can result in bleeding, infection, graft dysfunction and graft loss. We report the management of a renal transplant recipient who presented five months after renal transplantation with deterioration of renal function, who was found to have TRA pseudoaneurysm and TRA stenosis. Both were treated radiologically by using expandable hydrogel coils (EHC) in combination with stenting. Improvement in clinical, biochemical and radiological parameters were observed after the intervention. To our knowledge, this is the first report in the transplant literature on the use of EHC for the treatment of a TRA pseudoaneurysm.
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Affiliation(s)
- Yazin Marie
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, United Kingdom
| | - Avneesh Kumar
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, United Kingdom
| | - Sarah Hinchliffe
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, United Kingdom
| | - Simon Curran
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, United Kingdom
| | - Peter Brown
- Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, United Kingdom
| | - Douglas Turner
- Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, United Kingdom
| | - Badri Shrestha
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, United Kingdom
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Xue T, Chen Z, Lin W, Xu J, Shen X, Wang Z. Hydrogel coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms: a meta-analysis of randomized controlled trials. BMC Neurol 2018; 18:167. [PMID: 30290784 PMCID: PMC6172718 DOI: 10.1186/s12883-018-1171-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/28/2018] [Indexed: 11/30/2022] Open
Abstract
Background Recent studies have shown conflicting results regarding the effect of hydrogel coils for treating intracranial aneurysm compared to bare platinum coils. We implemented a meta-analysis to assess the value of hydrogel coils in intracranial aneurysm treatment. Methods The MEDLINE, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) which had evaluated hydrogel coils versus bare platinum coils for intracranial aneurysms. Results We pooled 1526 patients from 4 RCTs with the mean follow-up time of more than 16 months. Hydrogel coils had reductions on mid-term recurrence (RR 0.78, 95% CI 0.65 to 0.94, P = 0.008) and residual aneurysm (RR 0.71, 95% CI 0.57 to 0.88, P = 0.002), but didn’t show any significant differences in other favorable outcomes such as functional recovery, mortality and so on. In the subgroup analysis, we found that second-generation hydrogel coils might exhibit potential impacts on increasing mid-term complete occlusion (RR 1.26, 95% CI 1.07 to 1.48, P = 0.005) and decreasing residual aneurysm neck. (RR 0.54, 95% CI 0.34 to 0.86, P = 0.010). Conclusions Hydrogel coils showed no significant efficacy on functional recovery but exhibited a lower rate of recurrences and residual aneurysms in patients with intracranial aneurysms. Electronic supplementary material The online version of this article (10.1186/s12883-018-1171-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tao Xue
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China
| | - Zhouqing Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China
| | - Weiwei Lin
- University of Pittsburgh School of Pharmacy, Pittsburgh, PA, 15219, USA
| | - Jiayi Xu
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu Province, China
| | - Xuming Shen
- Department of Neurosurgery, Taicang Affiliated Hospital of Soochow University, Suzhou, 215400, Jiangsu Province, China.
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, China.
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Abi-Aad KR, Aoun RJN, Rahme RJ, Ward JD, Kniss J, Kwasny MJ, Sattur MG, Welz ME, Bendok BR. New generation Hydrogel Endovascular Aneurysm Treatment Trial (HEAT): a study protocol for a multicenter randomized controlled trial. Neuroradiology 2018; 60:1075-1084. [DOI: 10.1007/s00234-018-2074-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
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Fiorella D, Lylyk P, Szikora I, Kelly ME, Albuquerque FC, McDougall CG, Nelson PK. Curative cerebrovascular reconstruction with the Pipeline embolization device: the emergence of definitive endovascular therapy for intracranial aneurysms. J Neurointerv Surg 2018; 10:i9-i18. [DOI: 10.1136/jnis.2009.000083.rep] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 04/03/2009] [Indexed: 11/03/2022]
Abstract
Endovascular, endosaccular, coil embolization has emerged as an established therapy for both ruptured and unruptured cerebral aneurysms. However, many aneurysms are not cured using conventional endovascular techniques. Coil embolization often results in incomplete aneurysm occlusion or recanalization in the ensuing months after treatment. The Pipeline embolization device (PED; Chestnut Medical) represents a new generation endoluminal implant which is designed to treat aneurysms by reconstructing the diseased parent artery. Immediately after implantation, the PED functions to divert flow from the aneurysm, creating an environment conducive to thrombosis. With time, the PED is incorporated into the vessel wall as neointimal–endothelial overgrowth occurs along the construct. Ultimately, this process results in the durable complete exclusion of the aneurysm from the cerebrovasculature and a definitive endoluminal reconstruction of the diseased parent artery.
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Fabrication of Radiopaque Poly(vinyl alcohol) Hydrogel Bilayers for Use as Embolization Coils. Macromol Res 2018. [DOI: 10.1007/s13233-018-6083-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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McLaughlin A, Rice H, de Viliers L, Withers T, Pearson D, Arnell M, Walters K, Czuchwicki S, Bulmer A, Winearls J. Three-year experience with interventional neuroradiology for management of cerebral aneurysms at a single Australian centre. J Med Imaging Radiat Oncol 2017; 62:51-56. [PMID: 28726260 DOI: 10.1111/1754-9485.12634] [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: 01/10/2017] [Accepted: 05/07/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Over the last decade interventional neuroradiology (NR) has become the mainstay of managing cerebral aneurysms. The aim of our study was to review our growing experiences with interventional NR and quantify morbidity and mortality associated with these procedures. METHODS The electronic medical records of all patients admitted to the Gold Coast (University) Hospital Intensive Care Unit following subarachnoid haemorrhage (SAH) or elective interventional NR management of cerebral aneurysms between January 2012 and December 2014 were retrieved. Primary outcomes of interest were death, thromboembolic and haemorrhagic events during hospital admission. RESULTS One hundred and fifty-two patients underwent interventional NR procedures for cerebral aneurysms. This consisted of 92 (60.5%) elective cases and 60 (39.5%) emergency cases following SAH. The all-cause mortality rate and the rate of thromboembolic and haemorrhagic events for the entire cohort were 5.9%, 11.2% and 7.2% respectively. Intra-procedural complications occurred in 6.6% of the entire cohort. Median length of follow-up was 448 days, with 91.6% of the entire cohort followed up. At follow-up, 64.1% of patients had no neurological deficits, 29% had mild non-specific deficits and 6.9% had significant disability. CONCLUSIONS Interventional NR represents the primary treatment modality for all patients presenting to our service with cerebral aneurysm. Our results are encouraging and are comparable to published data in the international literature. Reducing the burden of thromboembolism in patients undergoing endovascular treatment of their aneurysmal disease is our main research focus currently, and we aim to improve outcomes for this patient group.
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Affiliation(s)
- Aden McLaughlin
- Department of Intensive Care and GCUH Critical Care Research Group, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Hal Rice
- Department of Interventional Radiology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Laetitia de Viliers
- Department of Interventional Radiology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Teresa Withers
- Department of Neurosurgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - David Pearson
- Department of Intensive Care and GCUH Critical Care Research Group, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Moira Arnell
- Department of Intensive Care and GCUH Critical Care Research Group, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Kerin Walters
- Department of Intensive Care and GCUH Critical Care Research Group, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Sarah Czuchwicki
- Department of Intensive Care and GCUH Critical Care Research Group, Gold Coast University Hospital, Southport, Queensland, Australia.,Heart Foundation Research Centre, School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Andrew Bulmer
- Department of Intensive Care and GCUH Critical Care Research Group, Gold Coast University Hospital, Southport, Queensland, Australia.,Heart Foundation Research Centre, School of Medicine, Griffith University, Southport, Queensland, Australia
| | - James Winearls
- Department of Intensive Care and GCUH Critical Care Research Group, Gold Coast University Hospital, Southport, Queensland, Australia
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Retrieval of Migrated Volume Coils Using Different Clot Retrievers in a Porcine Model. Clin Neuroradiol 2017; 28:593-600. [DOI: 10.1007/s00062-017-0600-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/15/2017] [Indexed: 11/25/2022]
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Raymond J, Klink R, Chagnon M, Barnwell SL, Evans AJ, Mocco J, Hoh BH, Turk AS, Turner RD, Desal H, Fiorella D, Bracard S, Weill A, Guilbert F, Lanthier S, Fox AJ, Darsaut TE, White PM, Roy D. Hydrogel versus Bare Platinum Coils in Patients with Large or Recurrent Aneurysms Prone to Recurrence after Endovascular Treatment: A Randomized Controlled Trial. AJNR Am J Neuroradiol 2017; 38:432-441. [PMID: 28082261 DOI: 10.3174/ajnr.a5101] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 12/14/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Some patients are at high risk of aneurysm recurrence after endovascular treatment: patients with large aneurysms (Patients Prone to Recurrence After Endovascular Treatment PRET-1) or with aneurysms that have previously recurred after coiling (PRET-2). We aimed to establish whether the use of hydrogel coils improved efficacy outcomes compared with bare platinum coils. MATERIALS AND METHODS PRET was an investigator-led, pragmatic, multicenter, parallel, randomized (1:1) trial. Randomized allocation was performed separately for patients in PRET-1 and PRET-2, by using a Web-based platform ensuring concealed allocation. The primary outcome was a composite of a residual/recurrent aneurysm, adjudicated by a blinded core laboratory, or retreatment, intracranial bleeding, or mass effect during the 18-month follow-up. Secondary outcomes included adverse events, mortality, and morbidity (mRS > 2). The hypothesis was that hydrogel would decrease the primary outcome from 50% to 30% at 18 months, necessitating 125 patients per group (500 for PRET-1 and PRET-2). RESULTS The trial was stopped once 250 patients in PRET-1 and 197 in PRET-2 had been recruited because of slow accrual. A poor primary outcome occurred in 44.4% (95% CI, 35.5%-53.2%) of those in PRET-1 allocated to platinum compared with 52.5% (95% CI, 43.4%-61.6%) of patients allocated to hydrogel (OR, 1.387; 95% CI, 0.838-2.295; P = .20) and in 49.0% (95% CI, 38.8%-59.1%) in PRET-2 allocated to platinum compared with 42.1% (95% CI, 32.0%-52.2%) allocated to hydrogel (OR, 0.959; 95% CI, 0.428-1.342; P = .34). Adverse events and morbidity were similar. There were 3.6% deaths (1.4% platinum, 5.9% hydrogel; P = .011). CONCLUSIONS Coiling of large and recurrent aneurysms is safe but often poorly effective according to angiographic results. Hydrogel coiling was not shown to be better than platinum.
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Affiliation(s)
- J Raymond
- From the Departments of Radiology (J.R., A.W., F.G., D.R.)
| | - R Klink
- Laboratory of Interventional Neuroradiology (R.K.), Research Centre of the Centre Hospitalier de l'Université de Montreal, Quebec, Canada
| | - M Chagnon
- Department of Mathematics and Statistics (M.C.), Université de Montréal, Montreal, Quebec, Canada
| | - S L Barnwell
- Department of Neurological Surgery (S.L.B.), Oregon Health and Science University, Portland, Oregon
| | - A J Evans
- Department of Radiology and Medical Imaging (A.J.E.), University of Virginia, Charlottesville, Virginia
| | - J Mocco
- Department of Neurosurgery (J.M.), Mount Sinai Health System, New York, New York
| | - B H Hoh
- Department of Neurosurgery (B.H.H.), University of Florida, Gainesville, Florida
| | - A S Turk
- Department of Neurosurgery (A.S.T., R.D.T.), Medical University of South Carolina, Charleston, South Carolina
| | - R D Turner
- Department of Neurosurgery (A.S.T., R.D.T.), Medical University of South Carolina, Charleston, South Carolina
| | - H Desal
- Service de Neuroradiologie Diagnostique et Interventionnelle (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - D Fiorella
- Cerebrovascular Center (D.F.), Stony Brook University Medical Center, Stony Brook, New York
| | - S Bracard
- Département de Neuroradiologie Diagnostique et Interventionnelle (S.B.), Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - A Weill
- From the Departments of Radiology (J.R., A.W., F.G., D.R.)
| | - F Guilbert
- From the Departments of Radiology (J.R., A.W., F.G., D.R.)
| | - S Lanthier
- Neurosciences (S.L.), Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
| | - A J Fox
- Department of Medical Imaging (A.J.F.), University of Toronto, Toronto, Ontario, Canada
| | - T E Darsaut
- Department of Surgery (T.E.D.), Division of Neurosurgery, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - P M White
- Stroke Research Group (P.M.W.), Institute of Neuroscience, Newcastle Upon Tyne, UK
| | - D Roy
- From the Departments of Radiology (J.R., A.W., F.G., D.R.)
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Cloutier F, Khoury N, Ghostine J, Farzin B, Kotowski M, Weill A, Roy D, Raymond J. Embolization with larger-caliber coils can increase packing density: Evidence from the pilot phase of a randomized trial. Interv Neuroradiol 2016; 23:14-17. [PMID: 27760884 DOI: 10.1177/1591019916668841] [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: 11/15/2022] Open
Abstract
Background and purpose Endovascular coil embolization of cerebral aneurysms is associated with suboptimal angiographic results in up to 20-30% of patients. Coil packing density has been used as an index of the success of the initial procedure. The trial sought to study the effects of using 15-caliber coils, as compared with 10-caliber coils, on packing density. Methods Does Embolization with Larger coils lead to better Treatment of Aneurysms (DELTA) is an investigator-initiated multicenter prospective, randomized, controlled clinical trial. Patients are randomized 1:1 to embolization with either 10-caliber coils exclusively (control group) or the highest safely achievable proportion of 15-caliber coils and 10-caliber coils if necessary (intervention group) in 4-12-mm aneurysms. The endpoint of the pilot phase of the trial was the capacity to increase packing density of the initial procedure, calculated using a mathematical transformation of the dimensions entered into the case report forms. Secondary outcomes included the total number of coils used per aneurysm, total fluoroscopy time, initial angiographic outcomes and any adverse or undesirable event. Results Seventy patients were recruited between June 2014 and November 2015. Compared with 10-caliber coils, the 15-caliber coil group had a higher median packing density (44% vs 24%, p = 0.017). Results of other outcome measures were similar for the two groups. Conclusion Coiling of small and medium aneurysms randomized to 15-caliber coils achieved higher packing densities compared with coiling using 10-caliber coils.
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Affiliation(s)
- Francis Cloutier
- 1 Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Canada
| | - Naim Khoury
- 2 Department of Interventional Neuroradiology, Université de Montréal, Canada
| | - Jimmy Ghostine
- 3 Department of Radiology, Centre Intégré Universitaire de Santé du Nord de Montréal, Canada
| | - Behzad Farzin
- 4 Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | - Marc Kotowski
- 1 Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Canada
| | - Alain Weill
- 1 Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Canada
| | - Daniel Roy
- 5 Centre Hospitalier de l'Université de Montréal, Canada
| | - Jean Raymond
- 1 Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Canada
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Retrieval of a migrated coil with a handmade microwire-snare device. Acta Neurochir (Wien) 2016; 158:1539-43. [PMID: 27250847 DOI: 10.1007/s00701-016-2857-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Intraprocedural coil migration during endovascular treatment of intracranial aneurysms is associated with potential vessel occlusion and thromboembolic complications. There is no standard management strategy for coil migration. Here, we describe our experience with using a handmade microwire-snare device (HMD) to retrieve a migrated coil. METHODS The HMD consists of a 0.017-inch microcatheter, a 0.014-inch microwire, and a 4-0 silk thread. The ring of the microwire-snare device can open, close, and twist in a figure eight pattern for coil entwinement. In addition, the ring can be shaped as needed to navigate tortuous vessels or capture the migrated coil. RESULTS The HMD was successfully used to retrieve two migrated coils. In the first case, the coil was displaced in the M2 branch of the middle cerebral artery. In the second case, the coil loop prolapsed into the parent artery. In both cases, control cerebral angiograms performed after retrieval confirmed the patency of the vessels and a lack of thromboembolic complications. At the 3-month follow-up, magnetic resonance angiography demonstrated stable patency of the affected vessels. CONCLUSIONS The HMD is a cost-effective, easy-to-use, safe, and universally available device for retrieving migrated coil(s) during intracranial aneurysm embolization procedures.
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Liu P, Lv X, Li Y, Lv M. High resolution MRI in treatment decision of anterior communicating artery aneurysm accompanied by visual symptoms: Endovascular treatment or surgical clipping? A report of two cases and literature review. Interv Neuroradiol 2016; 22:270-277. [PMID: 26809261 PMCID: PMC4984357 DOI: 10.1177/1591019915623559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 12/01/2015] [Indexed: 02/05/2023] Open
Abstract
Anterior communicating artery (AComA) aneurysm accompanied by visual symptoms is rarely reported. The first case is an asymptomatic 65-year-old woman who presented with an AComA aneurysm, and the pre-procedure high-resolution magnetic resonance imaging (MRI) revealed an AComA aneurysm compressed the left optic nerve and the chiasma with a size of 8.3 × 9.2 mm. She suffered a sudden onset of left eye visual loss and the temporal hemianopia of the right eye after endovascular embolization. She had a light sensation of the left eye and minor enlargement of the visual field in the right eye at the six-month follow-up. The second case is a symptomatic 55-year-old woman suffering a visual loss in the left eye and inferior nasal quadrantanopsia in her right eye. Pre-operative high-resolution MRI found an AComA aneurysm compressing the left part of the chiasma with a size of 7.1 × 8.3 mm. Her visual symptoms improved after surgical clipping. High-resolution MRI could depict the anatomic relationship between the AComA aneurysm and the surrounding optic pathways. Endovascular treatment of an AComA aneurysm may result in visual deterioration due to the mass effect or ischemia after the procedure. Surgical clipping of the AComA aneurysm could relieve the compression symptoms.
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Affiliation(s)
- Peng Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xianli Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Boileau X, Zeng H, Fahed R, Bing F, Makoyeva A, Darsaut TE, Savard P, Coutu B, Salazkin I, Raymond J. Bipolar radiofrequency ablation of aneurysm remnants after coil embolization can improve endovascular treatment of experimental bifurcation aneurysms. J Neurosurg 2016; 126:1537-1544. [PMID: 27203147 DOI: 10.3171/2016.3.jns152871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Endovascular treatment of aneurysms may result in incomplete initial occlusion and aneurysm recurrence at angiographic follow-up studies. This study aimed to assess the feasibility and efficacy of bipolar radiofrequency ablation (RFA) of aneurysm remnants after coil embolization. METHODS Bipolar RFA was accomplished using the coil mass as 1 electrode, while the second electrode was a stent placed across the aneurysmal neck. After preliminary experiments and protocol approval from the Animal Care committee, wide-necked bifurcation aneurysms were constructed in 24 animals. Aneurysms were allocated to 1 of 3 groups: partial intraoperative coil embolization, followed by RFA (n = 12; treated group) or without RFA (n = 6; control group 1); or attempted complete endovascular coil embolization 2-4 weeks later (n = 6; control group 2). Angiographic results were compared at baseline, immediately after RFA, and at 12 weeks, using an ordinal scale. Pathological results and neointima formation at the neck were compared using a semiquantitative grading scale. RESULTS Bipolar RFA was able to reliably target the aneurysm neck when the coil mass and stent were used as electrodes. RFA improved angiographic results immediately after partial coiling (p = 0.0024). Two RFA-related complications occurred, involving transient occlusion of 1 carotid artery and 1 hemorrhage from an adventitial arterial blister. At 12 weeks, angiographic results were improved with RFA (median score of 0), when compared with controls (median score of 2; p = 0.0013). Neointimal closure of the aneurysm neck was better with RFA compared with controls (p = 0.0003). CONCLUSIONS Bipolar RFA can improve results of embolization in experimental models by selectively ablating residual lesions after coil embolization.
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Affiliation(s)
- Xavier Boileau
- Centre Hospitalier de l'Université de Montréal Research Centre (CRCHUM), Notre-Dame Hospital, Interventional Neuroradiology Research Laboratory, Montreal, Quebec
| | - Han Zeng
- Centre Hospitalier de l'Université de Montréal Research Centre (CRCHUM), Notre-Dame Hospital, Interventional Neuroradiology Research Laboratory, Montreal, Quebec
| | - Robert Fahed
- Centre Hospitalier de l'Université de Montréal Research Centre (CRCHUM), Notre-Dame Hospital, Interventional Neuroradiology Research Laboratory, Montreal, Quebec
| | - Fabrice Bing
- Centre Hospitalier de l'Université de Montréal Research Centre (CRCHUM), Notre-Dame Hospital, Interventional Neuroradiology Research Laboratory, Montreal, Quebec.,Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Department of Radiology, Service of Neuroradiology, Montreal, Quebec
| | - Alina Makoyeva
- Centre Hospitalier de l'Université de Montréal Research Centre (CRCHUM), Notre-Dame Hospital, Interventional Neuroradiology Research Laboratory, Montreal, Quebec
| | - Tim E Darsaut
- University of Alberta Hospital, Mackenzie Health Sciences Centre, Department of Surgery, Division of Neurosurgery, Edmonton, Alberta
| | - Pierre Savard
- Institute of Biomedical Engineering, École Polytechnique de Montréal; and
| | - Benoit Coutu
- Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Department of Medicine, Service of Cardiology, Montreal, Quebec, Canada
| | - Igor Salazkin
- Centre Hospitalier de l'Université de Montréal Research Centre (CRCHUM), Notre-Dame Hospital, Interventional Neuroradiology Research Laboratory, Montreal, Quebec
| | - Jean Raymond
- Centre Hospitalier de l'Université de Montréal Research Centre (CRCHUM), Notre-Dame Hospital, Interventional Neuroradiology Research Laboratory, Montreal, Quebec.,Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Department of Radiology, Service of Neuroradiology, Montreal, Quebec
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Jeon JP, Cho YD, Rhim JK, Yoo DH, Cho WS, Kang HS, Kim JE, Han MH. Fate of Coiled Aneurysms with Minor Recanalization at 6 Months: Rate of Progression to Further Recanalization and Related Risk Factors. AJNR Am J Neuroradiol 2016; 37:1490-5. [PMID: 26965468 DOI: 10.3174/ajnr.a4763] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/28/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Minor recanalization in coiled aneurysms may remain stable with time or may progress to major recanalization. Our aim was to monitor the aneurysms displaying minor recanalization in imaging studies at 6 months, gauging major recanalization rates and related risk factors through extended follow-up. MATERIALS AND METHODS Sixty-five aneurysms (in 65 patients) showing minor recanalization in follow-up imaging at 6 months were reviewed retrospectively. Medical records and radiologic data accruing during extended monitoring (mean, 24.8 ± 8.2 months) were assessed. Univariate and multivariate analyses were conducted to identify risk factors for progression from minor-to-major recanalization. RESULTS Progression to major recanalization was observed in 24 (36.9%) of the initially qualifying aneurysms during a follow-up of 112.5 aneurysm-years, for an annual rate of 17.84% per aneurysm-year. Progression was determined chronologically as follows: 14 (58.3%) at 6 months, 8 (33.3%) at 18 months, and 2 (8.4%) at 30 months. Stent deployment significantly decreased the occurrence of major recanalization (OR = 0.22, P = .03), whereas antiplatelet therapy (OR = 0.82, P = .75), posterior location (OR = 0.24, P = .20), and second coiling for recanalized aneurysms (OR = 0.96, P = .96) were unrelated. CONCLUSIONS Our analysis determined a 36.9% rate of major recanalization during a follow-up of 112.5 aneurysm-years in coiled aneurysms showing minor recanalization at 6 months. Stent deployment alone conferred a protective effect, preventing further recanalization without additional treatment. Given the fair probability of late major recanalization, aneurysms showing minor recanalization at 6 months should be monitored diligently, particularly in the absence of stent placement.
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Affiliation(s)
- J P Jeon
- From the Department of Neurosurgery (J.P.J.), Hallym University College of Medicine, Chuncheon, Korea
| | - Y D Cho
- Departments of Radiology (Y.D.C., J.K.R., D.H.Y., M.H.H.)
| | - J K Rhim
- Departments of Radiology (Y.D.C., J.K.R., D.H.Y., M.H.H.)
| | - D H Yoo
- Departments of Radiology (Y.D.C., J.K.R., D.H.Y., M.H.H.)
| | - W-S Cho
- Neurosurgery (W.s.C., H.-S.K., J.E.K.), Seoul National University College of Medicine, Seoul, Korea
| | - H-S Kang
- Neurosurgery (W.s.C., H.-S.K., J.E.K.), Seoul National University College of Medicine, Seoul, Korea
| | - J E Kim
- Neurosurgery (W.s.C., H.-S.K., J.E.K.), Seoul National University College of Medicine, Seoul, Korea
| | - M H Han
- Departments of Radiology (Y.D.C., J.K.R., D.H.Y., M.H.H.)
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Jamali S, Fahed R, Gentric JC, Letourneau-Guillon L, Raoult H, Bing F, Estrade L, Nguyen TN, Tollard É, Ferre JC, Iancu D, Naggara O, Chagnon M, Weill A, Roy D, Fox AJ, Kallmes DF, Raymond J. Inter- and Intrarater Agreement on the Outcome of Endovascular Treatment of Aneurysms Using MRA. AJNR Am J Neuroradiol 2015; 37:879-84. [PMID: 26659336 DOI: 10.3174/ajnr.a4609] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/14/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Patients treated with coiling are often followed by MR angiography. Our objective was to assess the inter- and intraobserver agreement in diagnosing aneurysm remnants and recurrences by using multimodality imaging, including TOF MRA. MATERIALS AND METHODS A portfolio composed of 120 selected images from 56 patients was sent to 15 neuroradiologists from 10 institutions. For each case, raters were asked to classify angiographic results (3 classes) of 2 studies (32 MRA-MRA and 24 DSA-MRA pairs) and to provide a final judgment regarding the presence of a recurrence (no, minor, major). Six raters were asked to independently review the portfolio twice. A second study, restricted to 4 raters having full access to all images, was designed to validate the results of the electronic survey. RESULTS The proportion of cases judged to have a major recurrence varied between 16.1% and 71.4% (mean, 35.0% ± 12.7%). There was moderate agreement overall (κ = 0.474 ± 0.009), increasing to nearly substantial (κ = 0.581 ± 0.014) when the judgment was dichotomized (presence or absence of a major recurrence). Agreement on cases followed-up by MRA-MRA was similarly substantial (κ = 0.601 ± 0.018). The intrarater agreement varied between fair (κ = 0.257 ± 0.093) and substantial (κ= 0.699 ± 0.084), improving with a dichotomized judgment concerning MRA-MRA comparisons. Agreement was no better when raters had access to all images. CONCLUSIONS There is an important variability in the assessment of angiographic outcomes of endovascular treatments. Agreement on the presence of a major recurrence when comparing 2 MRA studies or the MRA with the last catheter angiographic study can be substantial.
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Affiliation(s)
- S Jamali
- From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada
| | - R Fahed
- From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada
| | - J-C Gentric
- From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada Groupe d'étude de la Thrombose en Bretagne Occidentale (J.-C.G.), Brest, France
| | - L Letourneau-Guillon
- From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada
| | - H Raoult
- Service de radiologie et imagerie médicale (H.R., J.-C.F.), Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - F Bing
- Service imagerie médicale et interventionnelle (F.B.), Centre Hospitalier Annecy Genevois, St-Julien en Genevois, France
| | - L Estrade
- Service Imagerie, Médecine nucléaire et Explorations fonctionnelles (L.E.), Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - T N Nguyen
- Departments of Neurology, Neurosurgery, and Radiology (T.N.N.), Boston Medical Center, Boston, Massachusetts
| | - É Tollard
- Service d'Imagerie Médicale (E.T.), Centre Hospitalier Universitaire Hôpitaux de Rouen, Charles Nicolle, Rouen, France
| | - J-C Ferre
- Service de radiologie et imagerie médicale (H.R., J.-C.F.), Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - D Iancu
- Service of Diagnostic Imaging (D.I.), The Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada
| | - O Naggara
- Service d'Imagerie Morphologique et Fonctionnelle (O.N.), Centre Hospitalier Sainte Anne, Paris, France
| | - M Chagnon
- Department of Mathematics and Statistics (M.C.), University of Montreal, Montreal, Quebec, Canada
| | - A Weill
- From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada
| | - D Roy
- From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada
| | - A J Fox
- Department of Medical Imaging (A.J.F.), University of Toronto, Toronto, Ontario, Canada
| | - D F Kallmes
- Department of Neurointerventional Radiology (D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - J Raymond
- From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada
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Broeders JA, Ahmed Ali U, Molyneux AJ, Poncyljusz W, Raymond J, White PM, Steinfort B. Bioactive versus bare platinum coils for the endovascular treatment of intracranial aneurysms: systematic review and meta-analysis of randomized clinical trials. J Neurointerv Surg 2015; 8:898-908. [PMID: 26359214 DOI: 10.1136/neurintsurg-2015-011881] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/26/2015] [Indexed: 12/21/2022]
Abstract
BackgroundBioactive coils were introduced in 2002 in an attempt to improve aneurysm healing and durability of angiographic results. Evidence demonstrating superior efficacy to justify the routine use of bioactive coils over bare coils is limited. We compared the periprocedural and clinical outcome after bioactive and bare platinum coiling for intracranial aneurysms.MethodsMEDLINE, EMBASE, Cochrane Library, and ISI Web of Knowledge Conference Proceedings Citation Index—Science were searched for randomized clinical trials (RCTs) comparing bioactive and bare coils. The methodological quality was evaluated to assess bias risk. Periprocedural outcomes and mid-term outcomes were compared.ResultsFive independent RCTs comparing bioactive (n=1084) and bare coils (n=1084) were identified. Periprocedural outcome was similar for both groups. Bioactive coiling increased the rate of complete aneurysm occlusion (47% vs 40%; RR 1.17 (95% CI 1.05 to 1.31); p=0.006) and reduced the rate of residual aneurysm neck at 10 months compared with bare coiling in the mid-term (26% vs 31%; RR 0.82 (95% CI 0.70 to 0.96); p=0.01). There were no differences in aneurysm recurrence, aneurysm rupture, stroke, neurological death, modified Rankin Scale score and reinterventions. Subgroup analysis for the three RCTs on hydrogel coils demonstrated reduction of residual aneurysms compared with bare coiling (25% vs 34%; RR 0.76 (95% CI 0.58 to 0.99); p=0.04).ConclusionsBioactive coils ensure a higher rate of medium-term complete aneurysm occlusion while reducing the rate of residual neck aneurysms compared with bare coiling in the mid-term. Hydrogel coils reduce residual aneurysms compared with bare coils. While there is level 1a evidence to show more complete aneurysm occlusion, longer term follow-up is needed to determine if this translates into clinical significance.
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Affiliation(s)
- Joris A Broeders
- Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Usama Ahmed Ali
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrew J Molyneux
- Neurovascular and Neuroradiology Research Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Wojciech Poncyljusz
- Department of Interventional Radiology, Pomeranian Medical University, Neurointerventional Cath Lab MSW Hospital, Szczecin, Poland
| | - Jean Raymond
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Laboratory of Interventional Neuroradiology Centre de recherche du Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada
| | - Phillip M White
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Brendan Steinfort
- Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Kim YS, Lee SW, Yeom JA, Yoon CH, Baik SK. Angiographic findings of in-stent intimal hyperplasia after stent-assisted coil embolization: are they permanent findings? J Neurosurg 2015; 124:328-33. [PMID: 26315002 DOI: 10.3171/2015.2.jns142557] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stent-assisted coil embolization for the treatment of intracranial aneurysms has been used widely. This study aimed to investigate the effect of stent implantation in the nonatherosclerotic parent artery with cerebral aneurysms. The authors evaluated luminal changes and the related factors following stent-assisted coil embolization. METHODS This study included 97 patients harboring a total of 99 unruptured aneurysms of the distal internal carotid artery (ICA) who underwent single-stent implantation and more than 1 session of conventional angiography during follow-up (midterm follow-up only, n = 70; midterm and long-term follow-up, n = 29) between January 2009 and April 2014. The luminal narrowing point was measured using a local thickness map (ImageJ plug-in). RESULTS Stent-assisted coil embolization caused dynamic luminal narrowing of approximately 82% of the parent artery diameter on average after 8 months, which was reversed to 91% after 25 months. In addition, luminal narrowing greater than 40% was noticed in 2 (7%) of the 29 patients who experienced spontaneous reversion without additional management during follow-up. Most luminal narrowing changes seen were diffuse. CONCLUSIONS Luminal narrowing after aneurysm stent-assisted coil embolization is a dynamic process and appears to be a spontaneously reversible event. Routine management of luminal narrowing may not cause adverse events that require additional treatment.
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Affiliation(s)
- Young Soo Kim
- Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang Won Lee
- Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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Brinjikji W, White PM, Nahser H, Wardlaw J, Sellar R, Gholkar A, Cloft HJ, Kallmes DF. HydroCoils Are Associated with Lower Angiographic Recurrence Rates Than Are Bare Platinum Coils in Treatment of "Difficult-to-Treat" Aneurysms: A Post Hoc Subgroup Analysis of the HELPS Trial. AJNR Am J Neuroradiol 2015; 36:1689-94. [PMID: 26228887 DOI: 10.3174/ajnr.a4349] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/30/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The HydroCoil Endovascular Aneurysm Occlusion and Packing Study was a randomized controlled trial that compared HydroCoils to bare platinum coils. Using data from this trial, we performed a subgroup analysis of angiographic and clinical outcomes of patients with "difficult-to-treat" aneurysms, defined as irregularly shaped and/or having a dome-to-neck ratio of <1.5. MATERIALS AND METHODS Separate subgroup analyses comparing outcomes of treatment with HydroCoils to that of bare platinum coils were performed for the following: 1) irregularly shaped aneurysms, 2) regularly shaped aneurysms, 3) aneurysms with a dome-to-neck ratio of <1.5, and 4) aneurysms with a dome-to-neck ratio of ≥1.5. For each subgroup analysis, the following outcomes were studied at the last follow-up (3-18 months): 1) any recurrence, 2) major recurrence, 3) re-treatment, and 4) an mRS score of ≤2. Multivariate logistic regression analysis was performed to determine if the HydroCoil was independently associated with improved outcomes in these subgroups. RESULTS Among the patients with an irregularly shaped aneurysm, the HydroCoil was associated with lower major recurrence rates than the bare platinum coils (17 of 66 [26%] vs 30 of 69 [44%], respectively; P = .046). Among the patients with an aneurysm with a small dome-to-neck ratio, the HydroCoil was associated with lower major recurrence rates than the bare platinum coils (18 of 73 [24.7%] vs 32 of 76 [42.1%], respectively; P = .02). No difference in major recurrence was seen between HydroCoils and bare platinum coils for regularly shaped aneurysms (42 of 152 [27.6%] vs 52 of 162 [32.1%], respectively; P = .39) or aneurysms with a large dome-to-neck ratio (41 of 145 [28.3%] vs 50 of 155 [32.3%], respectively; P = .53). CONCLUSIONS This unplanned post hoc subgroup analysis found that HydroCoils are associated with improved angiographic outcomes in the treatment of irregularly shaped aneurysms and aneurysms with a dome-to-neck ratio of <1.5. Because this was a post hoc analysis, these results are not reliable and absolutely should not alter clinical practice but, rather, may inform the design of future randomized controlled trials.
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Affiliation(s)
- W Brinjikji
- From the Department of Radiology (W.B., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - P M White
- Institute for Ageing and Health (P.M.W., A.G.), Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - H Nahser
- Department of Clinical Neuroscience (H.N.), University of Edinburgh, United Kingdom
| | - J Wardlaw
- Walton Centre (J.W., R.S.), Liverpool, United Kingdom
| | - R Sellar
- Walton Centre (J.W., R.S.), Liverpool, United Kingdom
| | - A Gholkar
- Institute for Ageing and Health (P.M.W., A.G.), Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - H J Cloft
- From the Department of Radiology (W.B., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - D F Kallmes
- From the Department of Radiology (W.B., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota
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Shimohira M, Kawai T, Hashizume T, Ohta K, Nakagawa M, Ozawa Y, Sakurai K, Shibamoto Y. Reperfusion Rates of Pulmonary Arteriovenous Malformations after Coil Embolization: Evaluation with Time-Resolved MR Angiography or Pulmonary Angiography. J Vasc Interv Radiol 2015; 26:856-864.e1. [DOI: 10.1016/j.jvir.2015.02.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 02/04/2015] [Accepted: 02/18/2015] [Indexed: 11/17/2022] Open
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Ernst M, Yoo AJ, Kriston L, Schönfeld MH, Vettorazzi E, Fiehler J. Is visual evaluation of aneurysm coiling a reliable study end point? Systematic review and meta-analysis. Stroke 2015; 46:1574-81. [PMID: 25944331 DOI: 10.1161/strokeaha.114.008513] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 04/10/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Angiographic occlusion as a surrogate marker of satisfactory aneurysm treatment is commonly used in clinical trials although some pitfalls have to be considered. To investigate the inter-rater reliability of visual rating of aneurysm occlusion as study end point, we performed a systematic review and meta-analysis. METHODS Electronic databases (MEDLINE, EMBASE, PubMed, and the Cochrane Library) were searched up to June 2014. Assessment of risk for bias was based on the Quality Appraisal Tool for Studies of Diagnostic Reliability and the Guidelines for Reporting Reliability and Agreement studies. Inter-rater reliability estimates were pooled across studies using meta-analysis, and the influence of several factors (eg, imaging methods, grading scales, and occlusion rate) was tested with meta-regression. RESULTS From 1193 titles, 644 abstracts and 87 full-text versions were reviewed. Twenty-six articles met the inclusion criteria and provided 77 reliability estimates. Twenty-one different rating scales were used, and statistical analysis varied. Mean inter-rater agreement of the pooled studies was substantial (κ=0.65; 95% confidence interval, 0.60-0.69). Reliability varied significantly as a function of imaging methods, grading scales, occlusion rates, and their interaction. Observer agreement substantially increased with increasing occlusion rate in digital subtraction angiography but not in MR angiography. Reliability was higher in studies using 2- or 3-value grading scales than in studies with 4-value grading scales. CONCLUSIONS There is significant heterogeneity between studies evaluating the reliability of visual evaluation of aneurysm coiling. On the basis of our analysis, we found that the combination of magnetic resonance angiography, 3-value grading scale, and 2 trained raters seems most promising for usage as surrogate study end points.
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Affiliation(s)
- Marielle Ernst
- From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.H.S., J.F.), Department of Medical Psychology (L.K.), and Department of Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (A.J.Y.).
| | - Albert J Yoo
- From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.H.S., J.F.), Department of Medical Psychology (L.K.), and Department of Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (A.J.Y.)
| | - Levente Kriston
- From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.H.S., J.F.), Department of Medical Psychology (L.K.), and Department of Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (A.J.Y.)
| | - Michael H Schönfeld
- From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.H.S., J.F.), Department of Medical Psychology (L.K.), and Department of Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (A.J.Y.)
| | - Eik Vettorazzi
- From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.H.S., J.F.), Department of Medical Psychology (L.K.), and Department of Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (A.J.Y.)
| | - Jens Fiehler
- From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.H.S., J.F.), Department of Medical Psychology (L.K.), and Department of Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (A.J.Y.)
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Brinjikji W, White PM, Nahser H, Wardlaw J, Sellar R, Cloft HJ, Kallmes DF. HydroCoils reduce recurrence rates in recently ruptured medium-sized intracranial aneurysms: a subgroup analysis of the HELPS trial. AJNR Am J Neuroradiol 2015; 36:1136-41. [PMID: 25767183 DOI: 10.3174/ajnr.a4266] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/11/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The HydroCoil Endovascular Aneurysm Occlusion and Packing Study (HELPS) was a randomized, controlled trial comparing HydroCoils with bare-platinum coils. The purpose of this study was to perform a subgroup analysis of angiographic and clinical outcomes of medium-sized aneurysms in the HELPS trial. MATERIALS AND METHODS Patients with medium-sized aneurysms (5-9.9 mm) were selected from the HELPS trial. Outcomes compared between the HydroCoil and bare-platinum groups included the following: 1) any recurrence, 2) major recurrence, 3) retreatment, and 4) mRS score of ≤2. Subgroup analysis by rupture status was performed. Multivariate logistic regression analysis adjusting for aneurysm neck size, shape, use of adjunctive device, and rupture status was performed. RESULTS Two hundred eighty-eight patients with medium-sized aneurysms were randomized (144 in each group). At 15-18 months posttreatment, the major recurrence rate was significantly lower in the HydroCoil group than in controls (18.6% versus 30.8%, P = .03, respectively). For patients with recently ruptured aneurysms, the major recurrence rate was significantly lower for the HydroCoil group than for controls (20.3% versus 47.5%, P = .003), while rates were similar between groups for unruptured aneurysms (16.7% versus 14.8%, P = .80). Multivariate analysis of patients with recently ruptured aneurysms demonstrated a lower odds of major recurrence with HydroCoils (OR = 0.27; 95% CI, 0.12-0.58; P = .0007). No difference in retreatment rates or mRS of ≤2 was seen between groups. CONCLUSIONS HydroCoils were associated with statistically significant and clinically relevant lower rates of major recurrence for recently ruptured, medium-sized aneurysms in the HELPS trial. Because this was not a prespecified subgroup analysis, these results should not alter clinical practice but, rather, provide insight into the design of future clinical trials comparing bare platinum with second-generation coils.
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Affiliation(s)
- W Brinjikji
- From the Department of Radiology (W.B., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - P M White
- Institute for Ageing and Health (P.M.W.), Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - H Nahser
- Department of Clinical Neuroscience (H.N.), University of Edinburgh, Edinburgh, United Kingdom
| | - J Wardlaw
- Walton Centre (J.W., R.S.), Liverpool, United Kingdom
| | - R Sellar
- Walton Centre (J.W., R.S.), Liverpool, United Kingdom
| | - H J Cloft
- From the Department of Radiology (W.B., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - D F Kallmes
- From the Department of Radiology (W.B., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota
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Jackson N, Verbrugghe P, Cuypers D, Adesanya K, Engel L, Glazer P, Dubruel P, Shacham-Diamand Y, Mendes E, Herijgers P, Stam F. A Cardiovascular Occlusion Method Based on the Use of a Smart Hydrogel. IEEE Trans Biomed Eng 2015; 62:399-406. [DOI: 10.1109/tbme.2014.2353933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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McDougall CG, Johnston SC, Gholkar A, Turk AS. Counterpoint-target aneurysm recurrence: measuring what matters. AJNR Am J Neuroradiol 2014; 36:4-6. [PMID: 25430860 DOI: 10.3174/ajnr.a4205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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