Second-Generation Hydrogel Coils for the Endovascular Treatment of Intracranial Aneurysms

Taschner, Christian; Chapot, René; Costalat, Vincent; Machi, Paolo; Courthéoux, P.; Barreau, Xavier; Berge, Jérôme; Piérot, Laurent; Kądziołka, Krzysztof; Jean, Betty; Blanc, Raphaël; Biondi, Alessandra; Brunel, H.; Gallas, Sophie; Berlis, Ansgar; Herbreteau, Denis; Berkefeld, Joachim; Urbach, Horst; Elsheikh, Samer; Fiehler, Jens; Desal, Hubert; Graf, Erika; Bonafé, Alain

doi:10.1161/strokeaha.117.018707

Cited by 48 publications

(45 citation statements)

References 17 publications

(31 reference statements)

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“…The higher packing density of HydroCoils seems to be translated into a lower reintervention rate compared with first-generation coils. 6 With a total mortality rate of 0.6% directly after discharge and 2.7% in long-term follow-up, our results are in the range of published outcomes. 7 In direct comparison with surgical clipping, the mortality rate after the endovascular technique was at least equal to recent published data (1.9%-2.0%).…”

Section: Comparison Between Surgical Clipping and Endovascular Techniquesupporting

confidence: 56%

Endovascular Treatment of Unruptured MCA Bifurcation Aneurysms Regardless of Aneurysm Morphology: Short- and Long-Term Follow-Up

Hagen

Maurer

Berlis

2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: The optimal treatment of unruptured middle cerebral aneurysms is still under debate. Although today almost any aneurysm can be treated endovascularly, there is a lack of data comparing endovascular and microsurgical repair of MCA aneurysms. The aim of our analysis is to provide data on the efficacy, clinical outcome, complications and re-treatment rates of endovascular treatment of this subtype of aneurysms. MATERIALS AND METHODS: Between May 2008 and July 2017, endovascular treatment of 1184 aneurysms in 827 patients was performed in our department. Twenty-four percent of these aneurysms were located at the MCA, and 150 unruptured MCA bifurcation aneurysms treated with coiling, stent-assisted-coiling, or endovascular flow diverter (WEB device) were identified for this retrospective data analysis. Ninety-six percent of all aneurysms, ruptured and unruptured, were treated by an endovascular approach, which yields a low selection bias for aneurysms suitable for endovascular treatment. Follow-up examinations were performed after 12 and 36 months and then every 1-3 years after embolization. Procedures were analyzed for periprocedural complications, outcome, and retreatment rate of the WEB (n ϭ 38) and coiling with (n ϭ 45) or without stent assistance (n ϭ 67). RESULTS: The procedure-associated good clinical outcome (mRS Ϲ 2) was 89.9%, and the mortality rate was 2.7%. Short-term follow-up good clinical outcome/mortality rates were 91.3%/0.7%. At discharge, 137 patients had an mRS of 0-2 (91.3%) and 13 had an mRS of 3-6 (8.7%). The retreatment rate was significantly higher in the WEB group (21.1%) compared with the coiling group with (5.9%) or without (2.2%) stent placement (P Ͻ .05). CONCLUSIONS: Regardless of the architecture of MCA bifurcation aneurysms, the endovascular treatment can be performed with low morbidity/mortality rates. The higher retreatment rate in the WEB group correlates with the learning curve in choosing the right device size.

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Section: Comparison Between Surgical Clipping and Endovascular Techniquesupporting

confidence: 56%

Endovascular Treatment of Unruptured MCA Bifurcation Aneurysms Regardless of Aneurysm Morphology: Short- and Long-Term Follow-Up

Hagen

Maurer

Berlis

2019

AJNR Am J Neuroradiol

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“…In Europe, the German-French Randomized Endovascular Aneurysm Trial (GREAT) showed that in a group of 484 patients (226 patients treated with hydrogel and 230 patients treated with bare platinum), 19.9% of patients treated with hydrogel had unfavourable outcomes such as aneurysm recurrence, retreatment, mRS (modified Rankin Scale) of 3–5 and death as compared with 28.7% of patients treated with bare platinum. The authors recommended the use of second-generation hydrogel coils 6. In the USA, a similar trial was conducted, called the New Generation Hydrogel Endovascular Aneurysm Treatment (HEAT) Trial, which examined aneurysm recurrence within 18 months post-treatment between patients who were treated with the second-generation HydroCoil Embolic System (HES) and patients treated with the traditional platinum coils.…”

Section: Advances In Coil Propertiesmentioning

confidence: 99%

“…Devices to augment coil embolisation now include balloon-assist techniques and intracranial stents to increase coil packing and parent artery patency, as well as reduce the risk of coil herniation 5. Significant changes in coil properties have also been made to increase the aneurysm occlusion rates 6…”

Section: Introductionmentioning

confidence: 99%

Advances in endovascular aneurysm management: coiling and adjunctive devices

et al. 2020

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Endovascular coil embolisation continues to evolve and remains a valid modality in managing ruptured and unruptured cerebral aneurysms. Technological advances in coil properties, adjunctive devices and interventional techniques continue to improve long-term aneurysm occlusion rates. This review elaborates on the latest advances in next-generation endovascular coils and adjunctive coiling techniques for treating cerebral aneurysms.on June 9, 2020 by guest. Protected by copyright.

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“…In contrast, Poncyljusz’s RCT concluded that hydrogel coils were equally as effective as bare platinum coils [ 17 ]. Later, the second-generation hydrogel (Hydrosoft, HydroFrame[3D], MicroVention, Inc) was developed, which was softer, contained less hydrogel, and expanded slower than the first-generation one [ 19 ]. In 2018, GREAT(German-French Randomized Endovascular Aneurysm Trial) was established, and some researchers found that compared to bare platinum coils, hydrogel coils decrease the rate of unfavorable outcome events, recurrence, retreatment, morbidity mortality, and need for retreatment in small- and medium-sized intracranial aneurysms [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Hydrogel coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms: a meta-analysis of randomized controlled trials

et al. 2018

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BackgroundRecent 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.MethodsThe 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.ResultsWe 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).ConclusionsHydrogel 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 materialThe online version of this article (10.1186/s12883-018-1171-8) contains supplementary material, which is available to authorized users.

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Second-Generation Hydrogel Coils for the Endovascular Treatment of Intracranial Aneurysms

Abstract: Supplemental Digital Content is available in the text.

Cited by 48 publications

References 17 publications

Endovascular Treatment of Unruptured MCA Bifurcation Aneurysms Regardless of Aneurysm Morphology: Short- and Long-Term Follow-Up

Endovascular Treatment of Unruptured MCA Bifurcation Aneurysms Regardless of Aneurysm Morphology: Short- and Long-Term Follow-Up

Advances in endovascular aneurysm management: coiling and adjunctive devices

Hydrogel coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms: a meta-analysis of randomized controlled trials

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