HOUSTON—Compared with standard platinum coils, second-generation hydrogel coils decrease the likelihood of adverse outcomes in the endovascular treatment of medium-sized intracranial aneurysms, according to research presented at the International Stroke Conference 2017. Hydrogel coils provide greater packing density and are associated with decreased risks of aneurysm recurrence and retreatment, compared with standard coils, according to the researchers.
Approximately 85% of subarachnoid hemorrhages result from ruptured intracranial aneurysms, which can be detected with CT angiography. A randomized controlled trial published in 2002 demonstrated that endovascular coiling was superior to neurosurgical clipping in the treatment of ruptured aneurysms. A drawback of coiling, however, is that it entails a relatively high rate of aneurysm recurrence. A novel approach adds a soft hydrogel filament into platinum coils. The hydrogel, once in contact with liquid, increases in volume, resulting in a greater fill of the underlying aneurysm.
Christian A. Taschner, MD, PhD
Between October 2009 and February 2014, Prof. Taschner and colleagues randomized 513 participants, and 29 patients were excluded from the analysis. The analysis included 243 patients treated with hydrogel coils and 241 patients treated with platinum coils. Of this population, 208 participants (43%) were treated for ruptured aneurysms.
Mean packing density was significantly higher in patients treated with hydrogel coils (39%), compared with patients treated with platinum coils (31%). At 18 months, the major recurrence rate was 12% in patients receiving hydrogel coils and 18% in patients receiving platinum coils. The retreatment rate at 18 months was 3% in patients receiving hydrogel coils and 6% in patients receiving platinum coils. The researchers found no difference in modified Rankin Scale score or mortality rate between groups.
In total, 45 patients in the hydrogel coil group and 66 controls had an adverse composite primary outcome. The hydrogel coils thus reduced the proportion of adverse composite primary outcomes, compared with platinum coils, by 8.4%, said Prof. Taschner.
—Erik Greb
Suggested Reading
Gaba RC, Ansari SA, Roy SS, et al. Embolization of intracranial aneurysms with hydrogel-coated coils versus inert platinum coils: effects on packing density, coil length and quantity, procedure performance, cost, length of hospital stay, and durability of therapy. Stroke. 2006;37(6):1443-1450.
Molyneux AJ, Kerr RS, Yu LM, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005;366(9488):809-817.
White PM, Lewis SC, Gholkar A, et al. Hydrogel-coated coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms (HELPS): a randomised controlled trial. Lancet. 2011;377(9778):1655-1662.