Single-center experience of cerecyte coils in the treatment of intracranial aneurysms: initial experience and early follow-up results

Endovascular Embolization of Intracranial Aneurysms Using Target Tetra Detachable Coils: Angiographic and Clinical Results from a Single Center

Background/Objectives: Target tetra detachable coils (TTDCs) aid in achieving effective framing during the coil embolization of small intracranial aneurysms by maintaining a tetrahedral conformation within the aneurysm sac. We aimed to report the initial experience of patients treated for intracranial aneurysms using TTDCs, with a specific focus on efficacy and safety. Methods: We retrospectively reviewed the medical records of 41 patients who underwent the coil embolization of intracranial aneurysms sized ≤10 mm with TTDCs between April and May 2023. Post-procedural angiographic and clinical results were reviewed. Results: Of the 46 aneurysms (45 unruptured and 1 ruptured), 33 (71.7%) were treated with the stent-assisted technique and 13 (28.3%) using the simple coil embolization technique. Post-procedural angiography showed complete occlusion in 41 aneurysms (89.1%), neck remnants in 1 (2.2%), and residual aneurysms in 4 (8.7%). The mean packing density was 34.7% (19.3-46.8%), with TTDC coil length comprising a mean of 88.5% of the total coil length. No major device- or procedure-related complications were observed. During the follow-up, 40 aneurysms (93.0%) demonstrated complete occlusion, while neck remnants were observed in 1 (2.3%), and residual aneurysms in 2 (4.7%). No cases of recanalization were observed. Conclusions: The TTDC is a safe and effective device for the endovascular treatment of intracranial aneurysms. Follow-up studies are required to establish long-term results.

Efficacy and Safety of Different Bioactive Coils in Intracranial Aneurysm Interventional Treatment, a Systematic Review and Bayesian Network Meta-Analysis

Background: Bioactive coils have been used for nearly 20 years to improve aneurysm treatments. Previous studies are inadequate for comparing the efficacy and safety between different coils. The aim of this study was to investigate the safety and efficacy of different coils by comparing the percentage of people with different modified Raymond scale grades, re-rupture rates, and mortality in patients with intracranial aneurysms embolized with different coils. Method: Randomized controlled trials (RCTs) containing coils for aneurysm interventional treatment were collected from Web of Science, PubMed, and the Cochrane Library up to December 2021. Bayesian network meta-analysis with a randomized or fixed model was performed to compare the efficacy and safety among different bioactive coils and bare platinum coils. Results: We pooled 3362 patients from eight RCTs. No significant differences were found between coils in the proportion of patients with a three-grade classification assessed with the modified Raymond scale immediately after surgery. Hydrogel coils did not show a significant difference in the percentage of patients with a modified Raymond scale grade I postoperatively compared with bare platinum coils (OR, −0.1080; 95% CI, −0.4201–0.2423), but at follow-up, the percentage of patients with modified Raymond scale grade I was significantly higher with hydrogel coils than with bare platinum coils (OR, 0.4957; 95% CI, 0.0060–0.9442). There were no statistical differences between these four coils in terms of aneurysm rupture or re-rupture rate and mortality. Conclusion: Though there was no significant difference in the embolization effect between the several coils in the postoperative period, complete embolization was more likely to be achieved with hydrogel coils compared to bare platinum coils at follow-up. There were no significant differences in safety between the several coil materials.

Coil type does not affect angiographic follow-up outcomes of cerebral aneurysm coiling: a systematic review and meta-analysis

BACKGROUND AND PURPOSE

Previous studies varied in their conclusions about the superiority of second-generation coils compared with bare platinum. In this systematic review and meta-analysis, we assessed differences in reported unfavorable angiographic outcomes of cerebral aneurysms treated with coil embolization as a function of coil type.

MATERIALS AND METHODS

This systematic review covered 1999-2011 through the use of Ovid MEDLINE and EMBASE. Search terms were "subarachnoid hemorrhage," "intracranial aneurysms," "endovascular treatment," and "coiling." Inclusion criteria were studies reporting >50 aneurysms with imaging follow-up. We defined "unfavorable angiographic outcome" as either "recanalization," <90% occlusion, or "incomplete occlusion" at follow-up. Rates of unfavorable outcomes were pooled through the use of random effects models and compared across various coil types. Multivariate random effects meta-regression models were used to further explore the differences in outcomes related to coil type.

RESULTS

We included 82 studies, comprising 90 patient cohorts, among which, 65 (72%) used bare platinum coils, 8 (8.9%) used Matrix, 11 (12%) used HydroCoil, and 6 (6.7%) used Cerecyte. The overall unfavorable outcome rate was 19% (95% CI: 17%,21%). Unfavorable outcome rates were 20% (95% CI: 17%, 22%) for bare platinum coils, 23% (95% CI: 16%, 29%) for Matrix, 15% (95% CI: 9%, 21%) for HydroCoil, and 15% (95% CI: 7%, 23%) for Cerecyte, respectively. The difference in unfavorable outcome rates among the various coil types was not statistically significant after adjusting for baseline characteristics, including aneurysm size, rupture status, and follow-up duration.

CONCLUSIONS

The rate of unfavorable angiographic outcomes was not statistically different across the major approved coil types. The quality of the evidence, however, remains low because of high heterogeneity, small sample size, and potential publication bias.

Initial experience with an extremely soft bare platinum coil, ED coil-10 Extra Soft, for endovascular treatment of cerebral aneurysms

BACKGROUND AND PURPOSE

The ED coil-10 Extra Soft (EDC-10 ES) is an extremely soft coil with excellent operability for embolization of cerebral aneurysms and is frequently used as a 'finishing coil'. The aim of this study was to evaluate the efficacy and safety of this coil.

METHODS

Clinical data were analyzed retrospectively for 92 consecutive aneurysms for which at least one EDC-10 ES was used. Follow-up angiography at 6 months was available for 69 aneurysms. Initial and follow-up outcomes were evaluated using three-category occlusion grading. Factors that affect the packing density were also investigated.

RESULTS

Of the 92 aneurysms, 63 (68.5%) were classified as complete occlusion, 11 (12.0%) as having a neck remnant and 18 (19.6%) with dome filling immediately after the embolization procedure. The mean ± SD packing density was 29.5 ± 10.6%. Periprocedural complications were observed in three cases (3.3%). At 6 months the rate of completely occluded cases increased to 78.3% (54/69) and those for neck remnant and dome filling decreased to 11.8% (8/69) and 10.1% (7/69), respectively. Recanalization occurred in six aneurysms and one aneurysm was retreated during the follow-up period, giving an overall recurrence rate of 10.0% (7/70). Linear regression analysis showed a significant association of packing density with the percentage EDC-10 ES volume (p<0.001) and with the maximum aneurysm size (p<0.001).

CONCLUSIONS

Use of the EDC-10 ES permits safe and effective embolization of a cerebral aneurysm and contributes to a reduction in the rate of recanalization.

Axium MicroFX coil for the completing endovascular aneurysm surgery study (ACCESS). A prospective evaluation of the safety and durability of Axium MicroFX PGLA coils

Recanalization of previously coiled aneurysms remains a major drawback of endovascular aneurysm therapy. We performed a prospective single arm trial to provide early initial data regarding the safety and angiographic durability of a new coil technology, the Axium MicroFX Polyglycolic/polylactic acid (PGLA) coil, which was designed to lower recanalization rates. Fifteen patients (16 aneurysms) were prospectively enrolled. Demographic and peri-procedural data were collected. Angiographic images of the initial coil embolization and three to six month follow-up angiographic images underwent blinded evaluation. Seven (47%) SAH and eight (53%) elective patients were enrolled. Blinded evaluation of the initial embolization demonstrated that 5/16 (31%) aneurysms achieved Raymond grade 1, 5/16 (31%) grade 2 and 6/16 (38%) grade 3. Three to six month angiography was obtained in 12/15 patients (80%); two patients expired (1 SAH, 1 elective) and one was lost to follow-up (SAH). All patients who underwent follow-up angiography had a mRS ≤1. Blinded evaluation of embolization demonstrated 7/13 aneurysms (54%) improved in Raymond grading, five (38%) were stable and one aneurysm (8%) worsened. One patient developed an asymptomatic peri-aneurysmal parent vessel stenosis. Axium MicroFX coils appear to be safe, though the small number of patients in this series obviates comparative analysis with other series. Further studies are needed with more patients to compare the angiographic durability of Axium MicroFX coils to other coils.

Cerecyte coil trial: procedural safety and clinical outcomes in patients with ruptured and unruptured intracranial aneurysms

BACKGROUND AND PURPOSE

This study arose from a need to systematically evaluate the clinical and angiographic outcomes of intracranial aneurysms treated with modified coils. We report the procedural safety and clinical outcomes in a prospective randomized controlled trial of endovascular coiling for ruptured and unruptured intracranial aneurysms, comparing polymer-loaded Cerecyte coils with bare platinum coils in 23 centers worldwide.

MATERIALS AND METHODS

Five hundred patients between 18 and 70 years of age with a ruptured or unruptured target aneurysm planning to undergo endovascular coiling were randomized to receive Cerecyte or bare platinum coils. Analysis was by intention to treat.

RESULTS

Two hundred forty-nine patients were allocated to Cerecyte coils and 251 to bare platinum coils. Baseline characteristics were balanced. For ruptured aneurysms, in-hospital mortality was 2/114 (1.8%) with Cerecyte versus 0/119 (0%) bare platinum coils. There were 8 (3.4%) adverse procedural events resulting in neurological deterioration: 5/114 (4.4%) with Cerecyte versus 3/119 (2.5%) with bare platinum coils (P = .22). The 6-month mRS score of ≤2 was not significantly different in 103/109 (94.5%) patients with Cerecyte and 110/112 (98.2%) patients with bare platinum coils. Poor outcome (mRS score of ≥3 or death) was 6/109 (5.5%) with Cerecyte versus 2/112 (1.8%) with bare platinum coils (P = .070). For UIAs, there was no in-hospital mortality. There were 7 (2.7%) adverse procedural events with neurological deterioration, 5/133 (3.8%) with Cerecyte versus 2/131 (1.5%) with bare platinum coils (P = .13). There was a 6-month mRS score of ≤2 in 114/119 (95.8%) patients with Cerecyte versus 123/123 (100%) patients with bare platinum coils. There was poor outcome (mRS ≥3 and 1 death) in 5/119 (4.2%) patients with Cerecyte versus 0/123 (0%) patients with bare platinum coils (P = .011).

CONCLUSIONS

There was a statistical excess of poor outcomes in the Cerecyte arm at discharge in the ruptured aneurysm group and at 6-month follow-up in the unruptured group. Overall adverse clinical outcomes and in-hospital mortality were exceptionally low in both groups.

Very late thrombosis of a pipeline embolization device construct: case report

BACKGROUND

The Pipeline embolization device (PED) is a new endoluminal construct designed to exclude aneurysms from the parent cerebrovasculature. We report the very late (>1 year) thrombosis of a PED construct placed for the treatment of a left vertebral aneurysm.

CLINICAL PRESENTATION

A patient with an occluded right vertebral artery and a large, fusiform intracranial left vertebral artery aneurysm was treated with PED and coil reconstruction. A durable, complete occlusion of the aneurysm was confirmed with control angiography at 1 year. The patient remained neurologically normal for 23 months until he experienced a transient visual disturbance followed weeks later by a minor brainstem stroke.

INTERVENTION

Imaging evaluation showed thrombosis of the PED construct with complete occlusion of the left vertebral artery. After this stroke, he was initially treated with dual antiplatelet therapy and was then converted to warfarin. The patient remained neurologically stable for 5 months until he experienced progressive basilar thrombosis that ultimately resulted in a fatal stroke.

CONCLUSION

The PED represents a promising new endovascular technology for the treatment of cerebral aneurysms; however, as an investigational device, long-term follow-up data are sparse at this point. The etiology of the very late thrombosis of the PED construct in this case remains unknown; however, this report underscores the need for a continued, careful systematic evaluation and close long-term follow-up of treated patients.

Comparison of bioactive coils and bare platinum coils for treatment of intracranial aneurysms: a matched-pair analysis

Object

The primary goal of this matched-pair analysis was to evaluate the durability of the treatment results with Cerecyte coils in comparison with that of bare platinum coils in terms of angiographic occlusion rates at follow-up.

Methods

Eighty aneurysms treated with Cerecyte coils were included in this study to carry out a matched-pair analysis. Every aneurysm treated with Cerecyte coils was matched with an aneurysm treated with bare platinum coils. Matching of the aneurysms was done according to the aneurysm size, location, neck size, initial occlusion grade, and clinical presentation.

Results

The initial treatment results were similar in both groups as part of a matching protocol. Subgroup analysis revealed a significant difference in the durability of occlusion in aneurysms that showed Raymond Class I obliteration on follow-up angiograms (69 [86.2%] in the Cerecyte group vs 51 [63.8%] in the control group, p = 0.002). Further thrombosis to Raymond Class I occlusions was higher in the Cerecyte group (17 [77.3%] of 22 vs 8 [36.4%] of 22 aneurysms).

Conclusions

Cerecyte coils provide further thrombosis and more durable results than bare platinum coils following coil embolization of cerebral aneurysms.

Cerecyte versus platinum coils in the treatment of intracranial aneurysms: packing attenuation and clinical and angiographic midterm results

BACKGROUND AND PURPOSE

As modifications are made to coils, monitoring the safety profile, ability to achieve high packing attenuation, and durability of occlusion as compared to the standard bare platinum coils is of paramount importance. We compared packing attenuation, initial occlusion, and recanalization rates between Cerecyte and bare platinum coils in the treatment of ruptured and unruptured cerebral aneurysms.

MATERIALS AND METHODS

We compared 63 patients (67 aneurysms) treated with Cerecyte coils with 65 patients (70 aneurysms) treated by using bare platinum coils. Results were classified by the Raymond score. Clinical outcomes were assessed by using a modified Rankin Scale. Angiographic and clinical follow-ups were performed routinely at 6 and 12 months after the intervention.

RESULTS

In the Cerecyte group, complete occlusion of the aneurysm (grade 1) was accomplished in 49% (33/67), a small residual neck (grade 2) was seen in 21% (14/67), and dome filling (grade 3) was seen in 30% (20/67). In the platinum group, 41% (29/70) were grade 1, 39% (27/70) were grade 2, and 20% (14/70) were grade 3 immediately postembolization. Mean packing attenuation was 43 +/- 28% in the Cerecyte group and 40 +/- 23% in the bare platinum group (P = .68). Twelve-month follow-up data were available for 54% (36/67) of the Cerecyte population and 43% (30/70) of the bare platinum population. There were 5 cases of neck recanalization (11%) in the Cerecyte group and 11 cases (23%) in the bare platinum group (P = .17). No rebleeds were noted in the follow-up period.

CONCLUSIONS

Cerecyte coils have a satisfactory safety profile. We were able to achieve high packing attenuations and initial occlusion rates similar to those obtainable with platinum coils.

Coiling of intracranial aneurysms: a systematic review on initial occlusion and reopening and retreatment rates

BACKGROUND AND PURPOSE

The proportion of incompletely occluded aneurysms after coiling varies widely between studies. To assess overall outcome of coiling, we systematically reviewed the literature to determine initial occlusion, reopening, and retreatment rates of coiled aneurysms according to predefined criteria and subgroups.

METHODS

We searched PubMed and EMBASE (January 1999 to September 2008) for studies of >50 coiled aneurysms. Two reviewers independently extracted data. We grouped studies reporting on only ruptured aneurysms, posterior circulation aneurysms, and studies with large proportions of aneurysms >10 mm to assess possible determinants for incomplete occlusion, reopening, and retreatment.

RESULTS

Forty-six studies totalling 8161 coiled aneurysms met inclusion criteria. Immediately after coiling, 91.2% (95% CI, 90.6% to 91.9%) of the aneurysms were adequately occluded. Aneurysm reopening occurred in 20.8% (95% CI, 19.8% to 21.9%) and retreatment was performed in 10.3% (95% CI, 9.5% to 11.0%). Reopening rate was lower in studies reporting on ruptured aneurysms only compared with all studies (11.4% versus 20.8%; relative risk, 0.55; 95% CI, 0.47 to 0.64) and higher in studies focusing on posterior circulation aneurysms compared with studies with >85% anterior circulation aneurysms (22.5% versus 15.5%; relative risk, 1.5; 95% CI,1.2 to 1.7). Regression analysis showed higher retreatment rates with increasing proportion of aneurysms >10 mm (beta=0.252; 95% CI, 0.073 to 0.432). We could not find a relation between reopening and type of coils used.

CONCLUSIONS

At follow-up, one fifth of all coiled intracranial aneurysms shows reopening of which half is retreated. Possible risk factors for aneurysm reopening are location in the posterior circulation and size >10 mm. To confirm our findings, a meta-analysis on individual well-reported patient data is desirable.

Angiographic and histologic comparison of experimental aneurysms embolized with hydrogel filaments

BACKGROUND AND PURPOSE

The embolization of aneurysms with hydrogel filaments allow postprocedural CT and MR imaging studies without artifacts. We compared the performance of 3 hydrogel filament formulations in rabbit experimental aneurysms by using angiography and histologic samples.

MATERIALS AND METHODS

Embolization of 35 rabbit elastase or bifurcation aneurysms was performed with 3 different formulations of detachable hydrogel filaments, including 1) polyethylene glycol opacified with aromatic iodine (PEG-I; n = 12), 2) polyethylene glycol opacified with barium sulfate (PEG-B; n = 12), or 3) polypropylene glycol opacified with barium sulfate (PPG-B; n = 11). Follow-up angiography was performed before the rabbits were killed at 2 (n = 7), 6 (n = 9), 10 (n = 8), or 26 (n = 11) weeks. Angiographic occlusion was scored according to the Raymond scale, and interval changes were assessed. The harvested aneurysms were evaluated on histologic examination. From the sections, we determined the percentage of the sac excluded from the vasculature and occupied by embolic devices by using image analysis. We compared results using the analysis of variance/t test or chi(2) test.

RESULTS

The mean number of devices used to treat aneurysms in the PPG-B group was significantly greater than that used for the other 2 groups, though aneurysm volumes were similar among groups. Compared with immediate posttreatment occlusion scores, mean angiographic occlusion at follow-up was increased for all 3 hydrogel filament groups. On histologic examination, thrombus organization, neointima formation, and inflammation were similar to that observed in rabbit experimental aneurysms with other embolic devices containing platinum coils.

CONCLUSIONS

The embolization of experimental aneurysms with hydrogel filaments resulted in durable angiographic and histologic occlusion from 2 to 26 weeks. With improvements, hydrogel filaments free from metallic coils show promise for endovascular use.

Spanish Registry for Embolization of Small Intracranial Aneurysms with Cerecyte Coils (SPAREC) Study. Early Experience and Mid-Term Follow-up Results

SUMMARY

This study aimed to report the results obtained in treating small ruptured and unruptured intracranial aneurysms using Cerecyte coils. A prospective, non-randomized multicenter registry operating in Spain with a reporting period between May 2005 and September 2007.We present clinical and angiographic results for 48 small aneurysms (26 ruptured, five with III cranial nerve paresis, and 17 incidental) that had undergone six months' follow-up. The volumetric percentage occlusion (VPO) achieved and percentage bioactive coils (PBC) used were assessed. No episodes of bleeding occurred during the follow-up period. The technical complication rate was 10.4% (five cases): four thromboembolic complications resolved with medication (8.3%) and one asymptomatic protrusion of a coil into the parent vessel. The clinical complication rate for the procedure was 2.1% (occlusion of the anterior choroidal artery in a ruptured anterior choroidal anaeurysm). Mean VPO was 25.2%. Balloon-assisted technique (BAT) was used in 60.4% of cases. The VPO was higher in the BAT-treated cases (P < 0.05). The overall six-month recanalization rate was 16.7% (12.5% minor and 4.2% major recanalizations). Neck size and VPO were unrelated to the recanalization rate. The PBC was higher in cases with progressive Deployment of the device is safe from the standpoint of periprocedural technical and clinical complications. No episodes of hemorrhage were recorded during follow-up. The sixmonth recanalization and retreatment rates compared favorably with most endovascular platinum and bioactive coil series.

Endovascular histologic effects of ultrathin gold- or vitronectin-coated platinum aneurysm coils in a rodent arterial occlusion model: a preliminary investigation

BACKGROUND AND PURPOSE

Novel stratagems to improve the efficacy of platinum coils in occluding cerebral aneurysms have primarily involved coating coils with materials thought likely to provoke more desirable histologic reactions. No investigations to date, however, have evaluated the utility of gold or vitronectin coatings, despite known endovascular histologic effects of these agents, which may be favorable for treating cerebral aneurysms. This study was conducted to evaluate the degree of endovascular histologic change associated with ultrathin gold- or vitronectin-coated platinum coils. It was hypothesized that such coatings would increase intra-aneurysmal intimal hyperplasia and the degree of luminal occlusion compared with standard platinum coils.

MATERIALS AND METHODS

The ligated carotid artery rat model was used to study 4 different aneurysm coil conditions: no coil (sham-surgery controls), uncoated platinum coil, and gold- or vitronectin-coated platinum coil. Two weeks postimplantation, the aneurysms were harvested and stained with hematoxylin-eosin. Slides were evaluated for the degree of neointimal response by a pathologist blinded to treatment. Additional quantitative evaluation was performed blindly by using the ratio of intimal-to-luminal cross-sectional area.

RESULTS

A gold- or vitronectin-coated platinum aneurysm coil produced a statistically significant increase in neointimal response compared with a sham (no coil). Arterial segments treated with gold-coated platinum coils also demonstrated a statistically significant 100% increase in neointimal response compared with those treated with bare platinum coils.

CONCLUSIONS

In concordance with our hypothesis, ultrathin coatings of gold provoked a neointimal response and degree of luminal occlusion greater than that of plain platinum aneurysm coils in a rat arterial occlusion model.

Endovascular coiling of cerebral aneurysms using "bioactive" or coated-coil technologies: a systematic review of the literature

SUMMARY

Second-generation coils have been available since 2002. We wanted to assess their performance and appraise available evidence. Therefore we performed a systematic review of the literature from 2002 to 2007. There were 27 studies with a total of 2390 patients that met pre-specified inclusion criteria. All studies were classed as having a high risk of bias. There were no randomized trials and for most studies results were not independently assessed and follow-up periods were short (mean 7 months). There were large differences in demographic and aneurysm characteristics, making comparisons between coil cohorts difficult. Procedure-related morbidity and mortality were similar for all coil types. Hemorrhagic events during follow-up were few, in the range of 1%/year for all coil types. The available literature is of poor quality and clinical series provide very little evidence in favor of second-generation coils. Positive randomized trial results are needed to justify routine clinical use. This systematic review illustrates the failure of the industry, the regulatory authorities, and the neurointerventional community combined to provide a reliable and prudent approach to the introduction of new devices.

Preliminary experience of cerecyte coils in the treatment of intracranial aneurysms

SUMMARY

Coil embolization of intracranial aneurysms is the first choice treatment in many centres worldwide. The ISAT study reported in favour of endovascular treatment even though coil embolization carries a higher risk of revascularization than surgical clipping. Bioactive coils boosting fibrosis within the aneurysm and neointimal production could counteract the tendency of embolized aneurysms to re-open. We reviewed our cohort in a retrospective study based on the following inclusion criteria: 1) Cerecyte coils (Micrus Endovascular, San Jose, Calif) were the only bioactive coils deployed. 2) Cerecyte coils were used in the first embolization procedure. Between July 2005 and December 2007 39 patients matched these inclusion criteria, 15 men and 24 women (average age 63.5 years) with 44 aneurysms. Treatment outcomes were: 30 aneurysms completed excluded from the circulation, 13 aneurysms almost completed excluded from the circulation, one incomplete aneurysm occlusion. Two aneurysms out of 44 recurred during follow-up (4.54%) and were re-embolized. The radio-opacity and conformational memory of the Cerecyte coils were satisfactory and they were easy to manoeuvre and detach.

Endovascular treatment of intracranial aneurysms with bioactive Cerecyte coils: effects on treatment stability

INTRODUCTION

The Cerecyte coils were developed to improve long-term stability of embolized cerebral aneurysms by producing an increased fibrous reaction over the neck of the aneurysms. We report our preliminary clinical experience with mid-term follow-up.

MATERIALS AND METHODS

Seventy-eight consecutive patients with 84 intracranial aneurysms treated exclusively with Cerecyte coils were included in this study. Forty-eight aneurysms were ruptured and 36 were incidental. Twenty-two aneurysms were small with (<10 mm) small neck (<4 mm) (SASN); 55 were small with wide neck (>or=4 mm) (SAWN); six were large (10-25 mm) (L); and one was giant (G) (>25 mm). The embolization technique was the same with that in standard bare coiling.

RESULTS

Immediate post-procedure angiography demonstrated complete aneurysm occlusion in 69%, neck remnant in 29.8% and incomplete occlusion in 1.2%. Follow-up angiography was obtained in 80 aneurysms in a period of time ranging from 6 months to 2 years. The overall recanalization rate was 11.3%, and the re-treatment rate was 6.3%; in the subgroup analysis, recanalization rates were 4.5% in S/S; 9.8% in S/W; and 33.3% in large aneurysms. The only giant aneurysm also showed recanalization. Procedure-related morbidity and mortality rates were 2.6% and 1.3%, respectively.

CONCLUSIONS

Our midterm results showed a relatively low rate of recurrence compared to those reported for platinum coils with morbidity and mortality rates comparable to those with standard bare platinum coils. The efficacy of Cerecyte coils in the long term will be specifically addressed by the ongoing randomized Cerecyte coil trial.

Results of 101 aneurysms treated with polyglycolic/polylactic acid microfilament nexus coils compared with historical controls treated with standard coils

BACKGROUND AND PURPOSE

Polyglycolic/polylactic acid (PGLA) addition to bare platinum coils is intended to reduce the reopening rate of coiled intracranial aneurysms. Nexus coils are standard complex platinum coils with interwoven PGLA microfilament threads. We present the clinical results of 101 intracranial aneurysms treated with Nexus coils.

MATERIALS AND METHODS

Results of coiling of 101 aneurysms treated with Nexus coils were compared with our results of coiling of 120 aneurysms with Guglielmi detachable coils (GDC 10) and 115 with Trufill coils treated between May 2003 and December 2004 with the same treatment protocol. Rate of complications, mean aneurysmal volume, packing attenuation, incomplete aneurysmal occlusion at 6 months, and rates of retreatment were compared.

RESULTS

Initial occlusion in aneurysms treated with Nexus coils was (near) complete in 97 aneurysms and incomplete in 4 aneurysms. There were no permanent procedural complications (0/95 patients, 0%; 97.5% CI, 0.0% to 3.3%). Mean aneurysmal volume was 180.2 mm(3) (range, 5-1624 mm(3)). Mean packing was 19.4% (range, 7.5% to 38.9%). Six months' angiographic follow-up in 87 of 101 aneurysms showed incomplete occlusion in 14 (16%), and 12 (14%) of those had additional coiling. Mean packing of 19.4% of Nexus coils was significantly lower than 22.9% for GDC 10 and 29.7% for Trufill coils. Other clinical results were not significantly different.

CONCLUSION

In this series, PGLA microfilament Nexus coils were safe to use with clinical results comparable with those of standard platinum coils. This study gives additional evidence of the lack of beneficial effect of PGLA addition to reduce the reopening rate of coiled intracranial aneurysms.