Bioactive versus Bare Platinum Coils in the Treatment of Intracranial Aneurysms: The MAPS (Matrix and Platinum Science) Trial

McDougall, Cameron G.; Johnston, S. Claiborne; Gholkar, A; Barnwell, Stanley L.; Suarez, J. C. Vazquez; Romero, Javier; Chaloupka, John C.; Bonafé, Alain; Wakhloo, Ajay K.; Tampieri, Donatella; Dowd, Christopher F.; Fox, Allan J.; Imm, S; Carroll, Kirsten; Turk, Aquilla S

doi:10.3174/ajnr.a3857

Cited by 124 publications

(89 citation statements)

References 21 publications

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“…What is not surprising in these high-risk patients, angiographic outcomes were inferior compared with those in other coiling trials. 16,17,22,23 Safety endpoints were similar for the 2 groups, except for a greater number of deaths unrelated to the aneurysm or treatment (7 versus 1) in the hydrogel group. A careful review of individual cases indicates that this difference is probably a chance finding.…”

Section: Discussionmentioning

confidence: 76%

“…15 Recurrent aneurysms after platinum coiling are at high risk of re-recurring when retreated, but these patients were excluded from all published randomized trials. 8,14,[16][17][18] The Patients Prone to Recurrence After Endovascular Treatment (PRET) study was designed in 2007 to offer an alternative to platinum coiling in patients previously shown to be at high risk of recurrence: patients with large (Ն10 mm) or recurrent aneurysms after coiling. The trial protocol was published in 2008.…”

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confidence: 99%

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Hydrogel versus Bare Platinum Coils in Patients with Large or Recurrent Aneurysms Prone to Recurrence after Endovascular Treatment: A Randomized Controlled Trial

Raymond

Klink

Chagnon

et al. 2017

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 76%

mentioning

confidence: 99%

Hydrogel versus Bare Platinum Coils in Patients with Large or Recurrent Aneurysms Prone to Recurrence after Endovascular Treatment: A Randomized Controlled Trial

Raymond

Klink

Chagnon

et al. 2017

AJNR Am J Neuroradiol

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“…4 Between the time of the initial treatment and the 1-year follow-up, of 484 aneurysms, 176 (36%) exhibited worsening occlusion, 167 (34%) showed no change, and 141 (29%) improved. Despite the significant rates of residual aneurysm filling reported in all 3 trials, the rehemorrhage rates in patients with ruptured aneurysms are very low.…”

mentioning

confidence: 99%

“…Importantly, in MAPS, residual aneurysm filling (Raymond class 3) was a strong predictor of the composite primary end point of the Target Aneurysm Recurrence (TAR) trial. 4 Overall, the best endovascular results, including those for treatment of ruptured and unruptured aneurysms, show complete obliteration < 60% of the time.…”

mentioning

confidence: 99%

The Barrow Ruptured Aneurysm Trial: 6-year results

Spetzler

McDougall

Zabramski

et al. 2015

JNS

360

176

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obJect The authors report the 6-year results of the Barrow Ruptured Aneurysm Trial (BRAT). This ongoing randomized trial, with the final goal of a 10-year follow-up, compares the safety and efficacy of surgical clip occlusion and endovascular coil embolization in patients presenting with subarachnoid hemorrhage (SAH) from a ruptured aneurysm. The 1- and 3-year results of this trial have been previously reported. methods In total, 500 patients with an SAH met the entry criteria and were enrolled in the study. Of these patients, 471 were randomly assigned to the treatments: 238 to surgical clipping and 233 to endovascular coiling. Six patients who died before treatment and 57 patients with nonaneurysmal SAHs were excluded, leaving a total of 408 patients who underwent clipping (209 assigned) or coiling (199 assigned). Whether to treat patients within the assigned group or to cross over patients to the other group was at the discretion of the treating physician; 38% (75/199) of the patients assigned to coiling were crossed over to clipping and 1.9% (4/209) assigned to clipping were crossed over to coiling. The outcome data were collected by a dedicated nurse practitioner. The primary outcome analysis was based on the assigned treatment group; poor outcome was defined as a modified Rankin Scale (mRS) score > 2 and was independently adjudicated. Six years after randomization, 336 (82%) of 408 patients who had been treated were available for examination. results On the basis of an mRS score of > 2, and similar to the results at the 3-year follow-up, no significant difference in outcomes (p = 0.24) was detected between the 2 treatment groups. Complete aneurysm obliteration at 6 years was achieved in 96% (111/116) of the clipping group and in 48% (23/48) of the coiling group (p < 0.0001). In the period between the 3- and 6-year follow-ups, 3 additional patients assigned to coiling and none assigned to clipping received retreatment, for overall retreatment rates of 4.6% (13/280) for clipping and 16.4% (21/128) for coiling (p < 0.0001). When aneurysm location was considered, the 6-year results continued to match the previously reported results, with no difference in outcome for anterior circulation aneurysms at most time points. Of the anterior circulation aneurysms assigned to coiling treatment, 42% (70/168) were crossed over to clipping treatment. The outcomes for posterior circulation aneurysms continued to favor coiling. The randomization process was unexpectedly skewed, with 18 of 21 treated aneurysms of the posterior inferior cerebellar artery (PICA) being assigned to clipping, but even when PICA aneurysms were removed from the analysis, outcomes for the posterior circulation aneurysms still favored coiling. coNclusioNs Although BRAT was statistically underpowered to detect small differences, these results suggest little difference in outcome between the 2 treatments for anterior circulation aneurysms. This was not the case for the posterior circulation aneurysms, where coil embolization appeared to provide a sustai...

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“…Multiple trials, including the MAPS (Matrix and Platinum Science) trial and the Cerecyte trial, have failed to show a decrease in recurrence based on coil types. 4,5 The HELPS (Hydrogel-coated coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms) trial demonstrated that hydrogel coils did not reduce late aneurysm rupture or improve outcome compared with bare-metal coils. 7 Even though one coil type has not been proven superior to another coil type, industry uses various pricing for similar types of coils.…”

Section: Discussionmentioning

confidence: 99%

Reducing costs while maintaining quality in endovascular neurosurgical procedures

Kashlan¹,

Wilson²,

Chaudhary

et al. 2014

JNS

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W ith health care reform headlining the media, both the US government and its citizens are acutely aware that funding medical care will continue to be a challenging problem as we face limited supplies and increasing demand. To this end, the cost-effectiveness of managing aneurysms using various endovascular techniques versus open microsurgical management has been much debated. Endovascular treatments are usually considered more costly, especially up-front procedures that include the use of expensive radiology equipment, catheters, and coils. Irrespective of this controversy, once a decision has been made to pursue endovascular management, measures should be undertaken to minimize costs while continuing to provide quality care.Costs associated with neurointerventional procedures can broadly be thought of in 3 categories: preoperative evaluation costs, procedure-related costs, and postoperative care costs. Within each category, several possible means exist for keeping costs down.At the University of Michigan, 3 simple policy changes were made to implement cost-cutting measures for procedure-related items: 1) decreasing the cost of contrast media, 2) optimizing coil prices via negotiation with vendors, and 3) minimizing the amount of opened but unused equipment. Specifically, in October 2008, an active effort was started to allow for the preferential use of Isovue (Bracco) contrast agent over Visipaque (General Electric Healthcare) contrast medium. Object. As medical costs continue to rise during a time of increasing medical resource utilization, both hospitals and physicians must attempt to limit superfluous health care expenses. Neurointerventional treatment has been shown to be costly, but it is often the best treatment available for certain neuropathologies. The authors studied the effects of 3 policy changes designed to limit the costs of performing neurointerventional procedures at the University of Michigan.Methods. The authors retrospectively analyzed the costs of performing neurointerventional procedures during the 6-month periods before and after the implementation of 3 cost-saving policies: 1) the use of an alternative, more economical contrast agent, 2) standardization of coil prices through negotiation with industry representatives to receive economies of scale, and 3) institution of a feedback method to show practitioners the costs of unused products per patient procedure. The costs during the 6-month time intervals before and after implementation were also compared with costs during the most recent 6-month time period.Results. The policy requiring use of a more economical contrast agent led to a decrease in the cost of contrast usage of $42.79 per procedure for the first 6 months after implementation, and $137.09 per procedure for the most current 6-month period, resulting in an estimated total savings of $62,924.31 for the most recent 6-month period. The standardized coil pricing system led to savings of $159.21 per coil after the policy change, and $188.07 per coil in the most recent 6-month period...

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Bioactive versus Bare Platinum Coils in the Treatment of Intracranial Aneurysms: The MAPS (Matrix and Platinum Science) Trial

Cited by 124 publications

References 21 publications

Hydrogel versus Bare Platinum Coils in Patients with Large or Recurrent Aneurysms Prone to Recurrence after Endovascular Treatment: A Randomized Controlled Trial

Hydrogel versus Bare Platinum Coils in Patients with Large or Recurrent Aneurysms Prone to Recurrence after Endovascular Treatment: A Randomized Controlled Trial

The Barrow Ruptured Aneurysm Trial: 6-year results

Reducing costs while maintaining quality in endovascular neurosurgical procedures

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