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Treatment of Intracranial Aneurysms with Hydrogel Coated Expandable Coils

Published online by Cambridge University Press:  02 December 2014

Thorsteinn Gunnarsson ,
Paula Klurfan ,
Karel G. terBrugge  and
Robert A. Willinsky
Thorsteinn Gunnarsson
Affiliation:
Division of Neuroradiology and the Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
Paula Klurfan
Affiliation:
Division of Neuroradiology , Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
Karel G. terBrugge
Affiliation:
Division of Neuroradiology , Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
Robert A. Willinsky
Affiliation:
Division of Neuroradiology , Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Abstract

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Background:

Coiling of intracranial aneurysms with platinum coils sometimes results in relatively poor angiographic results which may be is related to low packing volumes achieved. Hydrogel coated expandable coils (HydroCoil®) have been shown to achieve better aneurysm volume filling which may potentially result in lower recanalization rates. Currently there is limited clinical data on their safety and efficacy in aneurysm treatment.

Methods:

We analyzed data from a prospectively collected database on patients treated at the Toronto Western Hospital. The analysis included the patients' characteristics, aneurysm size, packing, procedure related complications, recanalization and clinical outcome.

Results:

Twenty-nine aneurysms were treated with HydroCoils only or in combination with other coils. The average calculated filling of the aneurysm volume was 74-76%. On the immediate post treatment angiograms, 44% of the berry type aneurysms were completely obliterated, 33% had a residual neck and, in 20%, a residual aneurysm was seen. Follow-up imaging was available in 23 cases. On imaging follow-up (from 2 days to 11 months) one dissecting aneurysm had recanalized. There were six technical/medical complications with no clinical consequences. Two clinically significant procedural related complications occurred.

Conclusion:

HydroCoils can be used effectively to treat intracranial aneurysms. The volume expansion allows for much greater packing than described for bare platinum coils, which may result in better long-term results. The recanalization rate is low but the limited follow-up does not allow for any conclusion regarding the long-term outcome. The complication rate is similar to larger current series using bare platinum coils.

Résumé:

RÉSUMÉ:Contexte:

Le traitement des anévrismes intracrâniens avec des microspires de platine donne parfois des résultats angiographiques peu satisfaisants qui sont peut-être dus au faible remplissage obtenu. Les microspires expansibles enduites d'hydrogel (HydroCoil,) permettent un meilleur remplissage de la cavité de l'anévrisme, ce qui est susceptible de diminuer le taux de reperméabilisation. Il existe peu de données cliniques au sujet de leur sécurité et de leur efficacité dans le traitement des anévrismes.

Méthodes:

Nous avons analysé les données d'une base de données accumulées de façon prospective sur des patients traités au Toronto Western Hospital. Les caractéristiques des patients, la taille de l'anévrisme, l'entassement des microspires, les complications suite à l'intervention, la reperméabilisation et l'issue clinique ont été analysés.

Résultats:

Vingt-neuf anévrismes ont été traités au moyen d'HydroCoils seulement ou combinés à d'autres microspires. Le remplissage calculé moyen du volume anévrismal a été de 74 à 76%. Àl'angiographie effectuée immédiatement après le traitement, 44% des anévrismes ampullaires étaient complètement oblitérés, 33% avaient un collet résiduel et un anévrisme résiduel était visible chez 20% des patients. L'imagerie effectuée au cours du suivi, soit de 2 jours à 11 mois après l'intervention, était disponible chez 23 patients. Un anévrisme disséquant était reperméabilisé. Il y a eu 6 complications techniques ou médicales sans conséquences cliniques et deux complications reliées à l'intervention qui étaient significatives au point de vue clinique.

Conclusions:

Les HydroCoils peuvent être utilisés efficacement pour traiter les anévrismes intracrâniens. Leur expansion permet de les entasser beaucoup plus que les microspires de platine nus, ce qui est susceptible de donner de meilleurs résultats à long terme. Dans cette étude, le taux de reperméabilisation est faible. Cependant, le suivi est trop court et ne permet pas de tirer des conclusions sur l'issue à long terme. Le taux de complication était semblable à celui de plus grandes séries de cas traités au moyen de microspires de platine nues.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 34 , Issue 1 , February 2007 , pp. 38 - 46
Copyright
Copyright © The Canadian Journal of Neurological 2007

References

1. Molyneux, A, Kerr, R, Stratton, I, Sandercock, P, Clarke, M, Shrimpton, J, et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet. 2002;360(9342):1267–74.CrossRefGoogle ScholarPubMed
2. Derdeyn, CP, Barr, JD, Berenstein, A, Connors, JJ, Dion, JE, Duckwiler, GR, et al. The International Subarachnoid Aneurysm Trial (ISAT): a position statement from the Executive Committee of the American Society of Interventional and Therapeutic Neuroradiology and the American Society of Neuroradiology. AJNR Am J Neuroradiol. 2003;24(7):1404–8.Google Scholar
3. Sluzewski, M, van Rooij, WJ, Slob, MJ, Bescos, JO, Slump, CH, Wijnalda, D. Relation between aneurysm volume, packing, and compaction in 145 cerebral aneurysms treated with coils. Radiology. 2004;231(3):653–8.CrossRefGoogle ScholarPubMed
4. Kallmes, DF, Fujiwara, NH. New expandable hydrogel-platinum coil hybrid device for aneurysm embolization. AJNR Am J Neuroradiol. 2002;23(9):1580–8.Google ScholarPubMed
5. Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale. J Neurosurg. 1988;68(6):985–6.Google Scholar
6. Kistler, JP, Crowell, RM, Davis, KR, Heros, R, Ojemann, RG, Zervas, T, et al. The relation of cerebral vasospasm to the extent and location of subarachnoid blood visualized by CT scan: a prospective study. Neurology. 1983;33(4):424–36.CrossRefGoogle Scholar
7. Arthur, AS, Wilson, SA, Dixit, S, Barr, JD. Hydrogel-coated coils for the treatment of cerebral aneurysms: preliminary results. Neurosurg Focus. 2005;18(2):E1.CrossRefGoogle ScholarPubMed
8. Cloft, HJ, Kallmes, DF. Aneurysm packing with HydroCoil Embolic System versus platinum coils: initial clinical experience. AJNR Am J Neuroradiol. 2004;25(1):60–2.Google ScholarPubMed
9. Farb, RI, Nag, S, Scott, JN, Willinsky, RA, Marotta, TR, Montanera, WJ, et al. Surveillance of intracranial aneurysms treated with detachable coils: a comparison of MRA Neuroradiology. 2005;47(7):507–15.CrossRefGoogle ScholarPubMed
10. Roy, D, Milot, G, Raymond, J. Endovascular treatment of unruptured aneurysms. Stroke. 2001;32(9):1998–2004.CrossRefGoogle ScholarPubMed
11. Guglielmi, G, Vinuela, F, Dion, J, Duckwiler, G. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: preliminary clinical experience. J Neurosurg. 1991;75(1):8–14.Google ScholarPubMed
12. Guglielmi, G, Vinuela, F, Sepetka, I, Macellari, V. Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: electrochemical basis, technique, and experimental results. J Neurosurg. 1991;75(1):1–7.Google ScholarPubMed
13. Raymond, J, Guilbert, F, Weill, A, Georganos, SA, Juravsky, L, Lambert, A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke. 2003;34(6):1398–403.CrossRefGoogle ScholarPubMed
14. Henkes, H, Fischer, S, Weber, W, Miloslavski, E, Felber, S, Brew, S, et al. Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results. Neurosurgery. 2004;54(2):268-8080; discussion 80-5.CrossRefGoogle ScholarPubMed
15. Koivisto, T, Vanninen, R, Hurskainen, H, Saari, T, Hernesniemi, J, Vapalahti, M. Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms. A prospective randomized study. Stroke. 2000;31(10):2369–77.Google ScholarPubMed
16. Sluzewski, M, van Rooij, WJ, Rinkel, GJ, Wijnalda, D. Endovascular treatment of ruptured intracranial aneurysms with detachable coils: long-term clinical and serial angiographic results. Radiology. 2003;227(3):720–4.CrossRefGoogle ScholarPubMed
17. Ng, P, Khangure, MS, Phatouros, CC, Bynevelt, M, ApSimon, H, McAuliffe, W. Endovascular treatment of intracranial aneurysms with Guglielmi detachable coils: analysis of midterm angiographic and clinical outcomes. Stroke. 2002;33(1):210–7.CrossRefGoogle ScholarPubMed
18. Murayama, Y, Nien, YL, Duckwiler, G, Gobin, YP, Jahan, R, Frazee, J, et al. Guglielmi detachable coil embolization of cerebral aneurysms: 11 years’ experience. J Neurosurg. 2003;98(5):959–66.CrossRefGoogle Scholar
19. Kai, Y, Hamada, J, Morioka, M, Yano, S, Kuratsu, J. Evaluation of the stability of small ruptured aneurysms with a small neck after embolization with Guglielmi detachable coils: correlation between coil packing ratio and coil compaction. Neurosurgery. 2005;56(4):785–92; discussion -92.CrossRefGoogle ScholarPubMed
20. Vallee, JN, Aymard, A, Vicaut, E, Reis, M, Merland, JJ. Endovascular treatment of basilar tip aneurysms with Guglielmi detachable coils: predictors of immediate and long-term results with multivariate analysis 6-year experience. Radiology. 2003; 226(3):867–79.CrossRefGoogle Scholar
21. Reul, J, Weis, J, Spetzger, U, Konert, T, Fricke, C, Thron, A. Long-term angiographic and histopathologic findings in experimental aneurysms of the carotid bifurcation embolized with platinum and tungsten coils. AJNR Am J Neuroradiol. 1997;18(1):35–42.Google ScholarPubMed
22. Kawanabe, Y, Sadato, A, Taki, W, Hashimoto, N. Endovascular occlusion of intracranial aneurysms with Guglielmi detachable coils: correlation between coil packing density and coil compaction. Acta Neurochir (Wien). 2001;143(5):451–5.CrossRefGoogle ScholarPubMed
23. Groden, C, Laudan, J, Gatchell, S, Zeumer, H. Three-dimensional pulsatile flow simulation before and after endovascular coil embolization of a terminal cerebral aneurysm. J Cereb Blood Flow Metab. 2001;21(12):1464–71.CrossRefGoogle ScholarPubMed
24. Reul, J, Spetzger, U, Weis, J, Sure, U, Gilsbach, JM, Thron, A. Endovascular occlusion of experimental aneurysms with detachable coils: influence of packing density and perioperative anticoagulation. Neurosurgery. 1997;41(5):1160–5; discussion 5-8.CrossRefGoogle ScholarPubMed
25. Slob, MJ, van Rooij, WJ, Sluzewski, M. Coil thickness and packing of cerebral aneurysms: a comparative study of two types of coils. AJNR Am J Neuroradiol. 2005;26(4):901–3.Google ScholarPubMed
26. Moret, J, Cognard, C, Weill, A, Castaings, L, Rey, A. The ‘remodelling technique’ in the treatment of wide neck intracranial aneurysms: angiographic results and clinical follow-up in 56 cases. Interventional Neuroradiology. 1997;3(1):21–35.CrossRefGoogle ScholarPubMed
27. dos Santos Souza, MP, Agid, R, Willinsky, RA, Cusimano, M, Montanera, W, Wallace, MC, et al. Microstent-assisted coiling for wide-necked intracranial aneurysms. Can J Neurol Sci. 2005;32(1):71–81.CrossRefGoogle ScholarPubMed
28. Piotin, M, Iijima, A, Wada, H, Moret, J. Increasing the packing of small aneurysms with complex-shaped coils: an in vitro study. AJNR Am J Neuroradiol. 2003;24(7):1446–8.Google ScholarPubMed
29. Piotin, M, Liebig, T, Feste, CD, Spelle, L, Mounayer, C, Moret, J. Increasing the packing of small aneurysms with soft coils: an in vitro study. Neuroradiology. 2004;46(11):935–9.CrossRefGoogle ScholarPubMed
30. Canton, G, Levy, DI, Lasheras, JC. Changes in the intraaneurysmal pressure due to HydroCoil embolization. AJNR Am J Neuroradiol. 2005;26(4):904–7.Google ScholarPubMed
31. Ding, YH, Dai, D, Lewis, DA, Cloft, HJ, Kallmes, DF. Angiographic and histologic analysis of experimental aneurysms embolized with platinum coils, Matrix, and HydroCoil. AJNR Am J Neuroradiol. 2005;26(7):1757–63.Google ScholarPubMed
32. Yoshino, Y, Niimi, Y, Song, JK, Silane, M, Berenstein, A. Endovascular treatment of intracranial aneurysms: comparative evaluation in a terminal bifurcation aneurysm model in dogs. J Neurosurg. 2004;101(6):996–1003.CrossRefGoogle Scholar
33. Kallmes, DF, Cloft, HJ. The use of hydrocoil for parent artery occlusion. AJNR Am J Neuroradiol. 2004;25(8):1409–10.Google ScholarPubMed
34. Brisman, JL, Song, JK, Niimi, Y, Berenstein, A. Treatment options for wide-necked intracranial aneurysms using a self-expandable hydrophilic coil and a self-expandable stent combination. AJNR Am J Neuroradiol 2005;26(5):1237–40.Google Scholar
35. Deshaies, EM, Bagla, S, Agner, C, Boulos, AS. Determination of filling volumes in HydroCoil-treated aneurysms by using three-dimensional computerized tomography angiography. Neurosurg Focus. 2005;18(2):E5.CrossRefGoogle ScholarPubMed
36. Arthur, AS, Wilson, SA, Barr, JD. Hydrocoils for the treatment of cerebral aneurysms: experience with 110 cases (abstract). Neurosurgery. 2006;58(2):408.CrossRefGoogle Scholar
37. Berenstein, A, Song, JK, Niimi, Y, Namba, K, Heran, NS, Brisman, JL, et al. Treatment of cerebral aneurysms with hydrogel-coated platinum coils: early results of the first 100 consecutive patients (abstract). Neurosurgery. 2006;58(2):409.CrossRefGoogle Scholar
38. Park, HK, Horowitz, M, Jungreis, C, Genevro, J, Koebbe, C, Levy, E, et al. Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol. 2005;26(3):506–14.Google ScholarPubMed
39. Raftopoulos, C, Mathurin, P, Boscherini, D, Billa, RF, Van Boven, M, Hantson, P. Prospective analysis of aneurysm treatment in a series of 103 consecutive patients when endovascular embolization is considered the first option. J Neurosurg. 2000;93(2):175–82.CrossRefGoogle Scholar
40. Bavinzski, G, Killer, M, Gruber, A, Reinprecht, A, Gross, CE, Richling, B. Treatment of basilar artery bifurcation aneurysms by using Guglielmi detachable coils: a 6-year experience. J Neurosurg. 1999;90(5):843–52.CrossRefGoogle Scholar
41. Klein, GE, Szolar, DH, Leber, KA, Karaic, R, Hausegger, KA. Basilar tip aneurysm: endovascular treatment with Guglielmi detachable coils--midterm results. Radiology. 1997;205(1):191–6.CrossRefGoogle ScholarPubMed
42. Workman, MJ, Cloft, HJ, Tong, FC, Dion, JE, Jensen, ME, Marx, WF, et al. Thrombus formation at the neck of cerebral aneurysms during treatment with Guglielmi detachable coils. AJNR Am J Neuroradiol. 2002;23(9):1568–76.Google ScholarPubMed
43. Meyers, PM, Lavine, SD, Fitzsimmons, BF, Commichau, C, Parra, A, Mayer, SA, et al. Chemical meningitis after cerebral aneurysm treatment using two second-generation aneurysm coils: report of two cases. Neurosurgery. 2004;55(5):1222.CrossRefGoogle ScholarPubMed
44. Willinsky, RA, Taylor, SM, TerBrugge, K, Farb, RI, Tomlinson, G, Montanera, W. Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology. 2003;227(2):522–8.CrossRefGoogle Scholar