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Embolization with hydrogel coils may reduce adverse events in endovascular treatment of intracranial aneurysm

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Patients with intracranial aneurysms who underwent embolization with second-generation hydrogel-coated coils were less likely to experience adverse outcomes than those treated with standard bare-platinum coils, according to data presented at the International Stroke Conference.

“Randomized controlled trials published in 2005 have shown the superiority of coiling vs. clipping in endovascular treatment of intracranial aneurysm, but the major drawback in coiling is a relatively high aneurysm recurrence rate,” Christian A. Taschner, MD, PhD, of the University Hospital Freiburg in Germany, said during a press conference. “The approach we used, which was the subject of our study, involves a novel coil that consists of a filament within the coil that in contact with liquid amplifies its volume, thereby increasing packing density of the coiled aneurysm.”

To determine if use of hydrogel coils, compared with standard platinum coils, improves outcomes, Taschner and colleagues conducted GREAT, a randomized, controlled, open-label trial with masked endpoint evaluation at 18 months. The primary endpoint was a composite outcome of major aneurysm recurrence, re-treatment for major recurrences, morbidity that prevented angiographic follow-up and death.

From October 2009 to January 2014, the researchers enrolled 513 adults with intracranial aneurysms at 15 sites in France and seven sites in Germany. Patients were randomly assigned to embolization with second-generation hydrogel coils (HydroSoft, HydroFrame; MicroVention) or bare-platinum coils. Forty-two percent of patients had ruptured aneurysms.

Mean coil volume was 0.041 cm³ in the hydrogel group and 0.038 cm³ in the platinum group, and mean packing density was significantly higher in the hydrogel group (39% vs. 31%; P = .0001), according to the study results.

At 18 months, the primary endpoint occurred in 19.9% of 243 patients in the hydrogel coil group and 28.7% of 241 patients in the platinum group. Reduction in the proportion of adverse primary outcomes with hydrogel coils, as stratified by rupture status, was 8.4% (95% CI, 0.5-16.2; P = .036).

For individual components of the composite outcome, rates of major recurrence were lower in the hydrogel coil group vs. the bare-platinum group (12% vs. 18%), as were rates of re-treatment (3% vs. 6%). However, rates of morbidity preventing angiography (1% and 0%, respectively) and death (3% and 4%) were similar, Taschner noted.

“According to our study, coil embolization with second-generation hydrogel coils decreases adverse outcomes in endovascular treatment of medium-sized intracranial aneurysms,” Taschner said. – by Melissa Foster

Reference:

Taschner C, et al. LB8. Presented at: International Stroke Conference; Feb. 22-24, 2017; Houston.

Disclosure: The study was funded MicroVention. Taschner reports financial ties with Acandis, Covidien, Microvention, Neuravi and Stryker Neurovascular.