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

Emerging and Current Biologics for the Treatment of Intracranial Aneurysms

The integration of biologics in endovascularly treated intracranial aneurysms is a significant area of focus in an evolving field. By presenting the clinical relevance, pathogenesis, management (historical and current), and emerging biologics themselves, this work provides a broad overview of the current landscape of the biologics under current investigation. Growth factors, cytokines, and biologic-coated coils are compared and described as modalities to increase healing, aneurysm occlusion, and long-term recovery. These emerging biologics may increase the efficacy and durability of less invasive endovascular methods and potentially change standard practice with continued exploration.

Fucoidan-coated coils improve healing in a rabbit elastase aneurysm model

BACKGROUND

Recanalization of coiled aneurysms remains unresolved. To limit aneurysm recanalization after embolization with coils, we propose an innovative approach to optimize aneurysm healing using fucoidan-coated coils.

OBJECTIVE

To evaluate the short-term efficacy and long-term safety of the new coil system with conventional angiography, histology, and multiphoton microscopy for follow-up of fibrosis and neointima formation.

METHODS

We conducted a feasibility study on rabbit elastase-induced aneurysms. Embolization was carried out with bare platinum coils, fucoidan-coated coils, or dextran-coated coils. Aneurysms were controlled after 1 month by digital subtraction angiography (DSA). Aneurysm samples were collected and processed for histological analysis. Aneurysm healing and fibrosis were measured by quantifying collagen according to the histological healing score by combining standard light microscopy and multiphoton imaging. We divided 27 rabbits into three groups: bare platinum group, fucoidan group, and dextran group as controls.

RESULTS

Angiographic grading showed a trend toward less recanalization in the fucoidan group, although there were no significant differences among the three groups (P=0.21). Histological healing was significantly different according to the presence of more collagen in the neck area of aneurysms in the fucoidan group versus the bare platinum group (P=0.011), but not in the dextran group. Histological index was significantly better at the aneurysm neck in the fucoidan group than in the bare platinum group (P=0.004). Collagen organization index was also significantly better in the fucoidan group than in the bare platinum group (P=0.007).

CONCLUSION

This proof-of-concept study demonstrated the feasibility and efficacy of treatment with fucoidan-coated coils to improve aneurysm healing. The results in this rabbit in vivo model showed that fucoidan-coated coils have the potential to improve healing following endovascular treatment.

Effect of exercise-nutrition-psychology oriented nursing in patients undergoing interventional embolization for intracranial aneurysm

AIM

To investigate the effect of exercise-nutrition-psychology oriented nursing in patients underwent interventional embolization for intracranial aneurysm.

METHODS

In this retrospective study, 60 patients diagnosed with intracranial aneurysm who underwent interventional embolization between January 2021 and June 2023 at Yichun People's Hospital were included. Among them, 28 patients received routine nursing intervention (control group), and the other 32 patients received exercise-nutrition-psychology oriented nursing (observational group). Quality of life, psychological state, self-management capacity, postoperative complications, patient satisfaction and medication compliance were compared between the two groups.

RESULTS

The self-management ability scores in the observation group were higher than those of the control group after the intervention (P<0.05). The overall satisfaction rate in the observation group was higher than that of the control group (P<0.05). The SF-36 scores of patients (psychological function, physiological function, physical symptoms, and social function) in the observation group improved more significantly compared with those of the control group (P<0.05). Moreover, the total occurrence rate of postoperative complication in the observation group was lower than that in the control group (3.1% VS. 10.7%, P<0.05). The results of multivariate regression analysis showed that exercise-nutrition-psychology oriented nursing and postoperative complication were independent factors affecting the prognosis of patients who underwent interventional embolization for intracranial aneurysm.

CONCLUSIONS

Exercise-nutrition-psychology oriented nursing can improve patients' self-management ability and quality of life, reduce the risk of complications, and promote the recovery of the condition.

Safety and Efficacy of Prestige Coils for Embolization of Vascular Abnormalities: The Embo-Prestige Study

A wide variety of coils are available for vascular embolization. This study aimed to evaluate the safety and efficacy of a new Prestige coil. We carried out retrospective analysis of a multicenter's registry data collected between February 2022 and November 2022. The choice of embolization agent used to treat peripheral vascular anomalies was left to the investigator's discretion. Patients for whom at least one Prestige coil was used were included in Series 1. All other patients were included in Series 2. Efficacy and safety were evaluated. Patients were followed up for one month. In total, 220 patients were included, 110 in each series. Patients included 149 men (67.7%) and 71 women (32.3%), with a median age of 62.5 years (IQR: 35.8-73). Patient ages were similar in the two series. Complete occlusion of the targeted vessel was reported in 96.4% (n = 106/110) of patients in Series 1 and in 99.7% (n = 109/110) in Series 2. Four patients experienced non-serious adverse events (1.8%, n = 4/220): one experienced back pain and one vomiting in Series 1; one patient had off-target embolization and one a puncture site hematoma in Series 2. Sixteen patients (7.2%, n = 16/220) were lost to follow up. Improvement in the patient's general state at one month was reported in 79.0% (n = 83/105) of patients in Series 1 and in 74.7% (n = 74/99) in Series 2. Ten deaths occurred, five in Series 1 (4.8%, n = 5/105) and five in Series 2 (5.1%, n = 5/99). These deaths all concerned critically ill patients embolized for emergent arterial bleeding. In conclusion, the 1-month follow-up showed that Prestige coils, alone or in combination, are efficient and safe.