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Duan G, Zhang Y, Li Q, Yang P, Zhang J, Wang H, Ma J, Guan S, Han Z, Yang H, Shi H, Liu Y, Liang C, Wu X, Wu Y, Zuo Q, Feng Z, Zhang L, Li Z, Zhou Y, Dai D, Fang Y, Huang Q, Xu Y, Zhao R, Liu J. Gekko Coil System for Intracranial Aneurysms Treatment in China (GREAT-China): A Prospective Randomized Controlled Open-Label Noninferiority Trial. World Neurosurg 2024; 185:181-192. [PMID: 38286321 DOI: 10.1016/j.wneu.2024.01.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/21/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVE This study aimed to evaluate the safety and efficacy of the Gekko coil system in treating intracranial aneurysms (IAs) in clinical practice. METHODS A prospective multicenter randomized open-label parallel positive control noninferiority trial was conducted by 11 centers in China. Patients with a target IA were randomized 1:1 to coiling with either Gekko or Axium coils. The primary outcome was successful aneurysm occlusion at 6 months postoperative follow-up, whereas the secondary outcomes included the successful occlusion aneurysm rate in the immediate postoperative period, recanalization rate at the 6 months follow-up, and technical success and security. RESULTS Between May 2018 and September 2020, 256 patients were enrolled and randomized. Per-protocol analysis showed that the successful aneurysm occlusion rate at 6 months was 96.08% for the Gekko coil group compared with 96.12% in the Axium coil group, with a difference of -0.04% (P = 0.877). The successful immediate aneurysm occlusion rates were 86.00% and 77.45% in the Gekko coil group and the Axium coil group, respectively, showing no significant difference between the 2 groups (P = 0.116), whereas the recanalization rates during the 6 months follow-up were 2.02% and 1.96% in the Gekko and Axium coil groups, respectively, which was not statistically significant (P = 1.000). CONCLUSIONS This trial showed that the Gekko coil system was noninferior to the Axium coil system in terms of efficacy and safety for IA embolization. In clinical practice, the Gekko coil system can be considered safe and effective for treating patients with IA.
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Affiliation(s)
- Guoli Duan
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yuhang Zhang
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Qiang Li
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Pengfei Yang
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Jianmin Zhang
- Department of Neurosurgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Honglei Wang
- Department of Neurovascular Surgery, The First Affiliated Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Jun Ma
- Department of Neurovascular Center, Nanjing Brain Hospital affiliated to Nanjing Medical University, Nanjing City, Jiangsu province, China
| | - Sheng Guan
- Department of Interventional Neuroradiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Zhian Han
- Department of Cerebrovascular Intervention, Zhongshan People's Hospital, Zhongshan City, Guangdong Province, China
| | - Hua Yang
- Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province, China
| | - Haibin Shi
- Department of interventional radiology, Jiangsu Provincial Hospital, Jiangsu Province, China
| | - Yunhui Liu
- Department of Neurosurgery, Shengjing Hospital Affiliated to China Medical University, Shenyang City, Liaoning Province, China
| | - Chuansheng Liang
- Department of Neurosurgery, The First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | - Xin Wu
- Department of Neurosurgery, Yantai Yuhuangding hospital, Yantai City, Shandong Province, China
| | - Yina Wu
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Qiao Zuo
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Zhengzhe Feng
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Lei Zhang
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - ZiFu Li
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yu Zhou
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Dongwei Dai
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yibin Fang
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Qinghai Huang
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yi Xu
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Rui Zhao
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Jianmin Liu
- Department of Neurovascular Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China.
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Nasra M, Maingard JT, Hall J, Mitreski G, Kuan Kok H, Smith PD, Russell JH, Jhamb A, Brooks DM, Asadi H. Clipping versus coiling: A critical re-examination of a decades old controversy. Interv Neuroradiol 2024; 30:86-93. [PMID: 36017537 PMCID: PMC10956463 DOI: 10.1177/15910199221122854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Two major studies, The International Subarachnoid Aneurysm Trial and the Barrow Ruptured Aneurysm Trial, compare the long-term outcomes of clipping and coiling. Although these demonstrated coiling's initial benefits, rebleeding and retreatment rates as well as converging patient outcomes sparked controversy regarding its durability. This article will critically examine the available evidence for and against clipping and coiling of intracranial aneurysms. Critics of endovascular treatment state that the initial benefit seen with endovascular coiling decreases over the duration of follow-up and eventually functional outcomes of both treatment modalities are similar. Combined with the increased rate of retreatment and rebleeding, these trials reveal that coiling is not as durable and not as effective as a long-term treatment compared to clipping. Also, due to the cost of devices following endovascular treatment and prolonged hospitalization following clipping, the financial burden has been considered controversial. SUMMARY/KEY MESSAGES Short-term outcomes reveal better morbidity and mortality outcomes following coiling. Despite the higher rates of retreatment and rebleeding with coiling, there was no significant change in functional outcomes following retreatment. Furthermore, examining more recent trials reveals a decreased rate of recurrence and rebleeding with improved technology and expertise. Functional outcomes deteriorate for both cohorts over time while recent results revealed improved long-term cognitive outcomes and levels of health-related quality of life after coiling in comparison to clipping. The expense of longer hospital stays following clipping must be balanced against the expense of endovascular devices in coiling.
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Affiliation(s)
| | - Julian Tam Maingard
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia
- Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia
| | - Jonathan Hall
- Department of Interventional Radiology, St Vincent's Health Australia, Fitzroy, Victoria, Australia
| | - Goran Mitreski
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia
| | - Hong Kuan Kok
- Interventional Radiology Service, Northern Hospital, Epping, Victoria, Australia
| | - Paul D. Smith
- Department of Neurosurgery, St Vincent's Hospital, Fitzroy, Victoria, Melbourne, Australia
- Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Jeremy H. Russell
- Department of Neurosurgery, Austin Health, Heidelberg, Victoria, Australia
| | - Ashu Jhamb
- Department of Interventional Radiology, St Vincent's Health Australia, Fitzroy, Victoria, Australia
| | - Duncan Mark Brooks
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia
- School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia
| | - Hamed Asadi
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia
- School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
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3
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Kappel AD, Nguyen HB, Frerichs KU, Patel NJ, Aziz-Sultan MA, Du R. Randomized Clinical Trials in Cerebrovascular Neurosurgery From 2018 to 2022. Cureus 2024; 16:e52397. [PMID: 38361699 PMCID: PMC10869144 DOI: 10.7759/cureus.52397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
There has been an exponential increase in randomized controlled trials (RCTs) on cerebrovascular disease within neurosurgery. The goal of this study was to review, outline the scope, and summarize all phase 2b and phase 3 RCTs impacting cerebrovascular neurosurgery practice since 2018. We searched PubMed, MEDLINE, Embase, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases for relevant RCTs published between January 1, 2018, and July 1, 2022. We searched for studies related to eight major cerebrovascular disorders relevant to neurosurgery, including acute ischemic stroke, cerebral aneurysms and subarachnoid hemorrhage, intracerebral hemorrhage, subdural hematomas, cerebral venous thrombosis, arteriovenous malformations, Moyamoya disease and extracranial-intracranial bypass, and carotid and intracranial atherosclerosis. We limited our search to phase 2b or 3 RCTs related to cerebrovascular disorders published during the study period. The titles and abstracts of all relevant studies meeting our search criteria were included. Pediatric studies, stroke studies related to rehabilitation or cardiovascular disease, study protocols without published results, prospective cohort studies, registry studies, cluster randomized trials, and nonrandomized pivotal trials were excluded. From an initial total of 2,797 records retrieved from the database searches, 1,641 records were screened after duplicates and studies outside of our time period were removed. After screening, 511 available reports within our time period of interest were assessed for eligibility. Pediatric studies, stroke studies related to rehabilitation or cardiovascular disease, study protocols without published results, prospective cohort studies, registry studies, cluster randomized trials, and nonrandomized pivotal trials were excluded. We found 80 unique phase 2b or 3 RCTs that fit our criteria, with 165 topic-relevant articles published within the study period. Numerous RCTs in cerebrovascular neurosurgery have been published since 2018. Ischemic stroke, including mechanical thrombectomy and thrombolysis, accounted for a majority of publications, but there were large trials in intracerebral hemorrhage, subdural hemorrhage, aneurysms, subarachnoid hemorrhage, and cerebral venous thrombosis, among others. This review helps define the scope of the large RCTs published in the last four years to guide future research and clinical care.
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Affiliation(s)
- Ari D Kappel
- Neurosurgery, Brigham and Women's Hospital, Boston, USA
| | | | | | - Nirav J Patel
- Neurosurgery, Brigham and Women's Hospital, Boston, USA
| | | | - Rose Du
- Neurosurgery, Brigham and Women's Hospital, Boston, USA
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4
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Echeverría D, Rivera R, Giacaman P, Sordo JG, Einersen M, Badilla L. A novel self-expanding shape memory polymer coil for intracranial aneurysm embolization: 1 year follow-up in Chile. J Neurointerv Surg 2023; 15:781-786. [PMID: 35831177 PMCID: PMC10359521 DOI: 10.1136/jnis-2022-018996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/21/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Aneurysm recurrence remains a challenge when coiling cerebral aneurysms. Development of next generation coils has focused on accelerating thrombus maturation and increasing coil packing density. Ultra low density shape memory polymer is a novel embolic material designed for this purpose. The polymer is crimped over a platinum-tungsten coil for catheter delivery and self-expands to a predefined volume on contact with blood. METHODS This prospective study in humans evaluated aneurysms 5-16 mm (inclusive) in diameter that were indicated for endovascular coil embolization. At least 70% coil volume was required to be shape memory polymer coils. Patients were followed-up according to standard of care for 12 months. RESULTS Nine patients (89% women, mean age 55.8±11.7 years) were treated with shape memory polymer coils and completed 12 months of follow-up. Aneurysms were all unruptured and were in the ophthalmic segment of the internal carotid artery (n=7), posterior communicating artery, and anterior cerebral artery A1-A2 segment. Aneurysms were a mean of 7.8±2.9 mm in diameter (range 5.2-14.9 mm). The mean packing density based on unexpanded polymer was 17±6%. Packing density based on expanded polymer was 43±13%. At 12 months, no recurrence had occurred, and a Raymond-Roy occlusion classification of 1 (n=5) or 2 (n=4) was observed. No serious adverse events related to the study device occurred over the 12 months after the procedure. CONCLUSIONS Shape memory polymer coils were safe and effective in treating intracranial aneurysms over 12 months in this first study in human subjects.
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Affiliation(s)
- Daniel Echeverría
- Neuroradiology, Instituto de Neurocirugía Dr Alfonso Asenjo, Santiago, Chile
- Department of Radiology, Universidad de Valparaíso, Valparaíso, Chile
| | - Rodrigo Rivera
- Neuroradiology, Instituto de Neurocirugía Dr Alfonso Asenjo, Santiago, Chile
- Department of Radiology, Universidad de Valparaíso, Valparaíso, Chile
| | - Pablo Giacaman
- Neurovascular Unit, Imaging Service, Hospital Clínico Regional Guillermo Grant Benavente, Concepción, Chile
| | - Juan Gabriel Sordo
- Neuroradiology, Instituto de Neurocirugía Dr Alfonso Asenjo, Santiago, Chile
- Department of Radiology, Universidad de Valparaíso, Valparaíso, Chile
| | - Martín Einersen
- Neurovascular Unit, Imaging Service, Hospital Clínico Regional Guillermo Grant Benavente, Concepción, Chile
- Faculty of Medicine, Department of Specialties (Imaging), Universidad de Concepción, Concepción, Chile
| | - Lautaro Badilla
- Neuroradiology, Instituto de Neurocirugía Dr Alfonso Asenjo, Santiago, Chile
- Department of Radiology, Universidad de Valparaíso, Valparaíso, Chile
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5
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Jindal G, Almardawi R, Gupta R, Colby GP, Schirmer CM, Satti SR, Pukenas B, Hui FK, Caplan J, Miller T, Cherian J, Aldrich F, Kibria G, Simard JM. Target Ultra and Nano coils in the endovascular treatment of small intracranial aneurysms (ULTRA Registry). J Neurosurg 2023; 138:233-240. [PMID: 35901755 DOI: 10.3171/2022.5.jns2296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/04/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The ULTRA Registry is a national multicenter prospective study designed to assess aneurysm occlusion rates and safety profiles of the Target Ultra and Nano coils in the treatment of small intracranial aneurysms (IAs). METHODS Patients with small (≤ 5 mm) ruptured and unruptured IAs were treated exclusively with Target Ultra and Nano coils. The primary endpoints were the initial rate of complete or near-complete aneurysm occlusion, aneurysm recurrence, and need for retreatment. Secondary endpoints were device- and procedure-related adverse events, hemorrhage from the coiled aneurysm at any time during follow-up, and clinical outcomes. RESULTS The ULTRA Registry included 100 patients with a mean ± SD age of 56 ± 11.6 years, of whom 75 were women and 48 presented after aneurysm rupture. The mean aneurysm size was (3.5 ± 0.9) × (2.8 ± 0.9) × (3.0 ± 1.0) mm, and the mean packing density was 34.4% ± 16.7%. Posttreatment complete or near-complete occlusion reported by an independent imaging core laboratory was seen in 92% of patients at baseline and in 87%, 87%, and 83% of patients at first, second, and final follow-up, respectively. At first, second, and final follow-up, 10%, 11%, and 15%, respectively, of patients were deemed to require retreatment. There were three procedural-related ischemic strokes and one intracranial hemorrhage from wire perforation of a parent artery not involved by the aneurysm. There were no coil-related adverse events, including no intraoperative aneurysm ruptures and no known aneurysm ruptures after coiling. CONCLUSIONS This assessment of aneurysm occlusion rates and safety profiles in ULTRA Registry study participants demonstrates excellent safety and efficacy profiles for Target Ultra and Nano coils in the treatment of small IAs.
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Affiliation(s)
- Gaurav Jindal
- 1Department of Radiology, Division of Interventional Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
| | - Ranyah Almardawi
- 1Department of Radiology, Division of Interventional Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
| | - Rishi Gupta
- 2Department of Neurosurgery, Wellstar Health System, Marietta, Georgia
| | - Geoffrey P Colby
- 3Department of Neurosurgery, University of California, Los Angeles, California
| | - Clemens M Schirmer
- 4Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania
| | - Sudhakar R Satti
- 5Department of Neurointerventional Surgery, Christiana Care Medical Center, Newark, Delaware
| | - Bryan Pukenas
- 6Department of Radiology, Division of Interventional Neuroradiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ferdinand K Hui
- 7Department of Radiology, Division of Interventional Neuroradiology, and
| | - Justin Caplan
- 8Department of Neurosurgery, Johns Hopkins Hospital, Baltimore
| | - Timothy Miller
- 1Department of Radiology, Division of Interventional Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
| | - Jacob Cherian
- 9Department of Neurosurgery, University of Maryland Medical Center, Baltimore; and
| | - Francois Aldrich
- 9Department of Neurosurgery, University of Maryland Medical Center, Baltimore; and
| | - Gulam Kibria
- 10Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - J Marc Simard
- 9Department of Neurosurgery, University of Maryland Medical Center, Baltimore; and
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Lauzier DC, Huguenard AL, Srienc AI, Cler SJ, Osbun JW, Chatterjee AR, Vellimana AK, Kansagra AP, Derdeyn CP, Cross DT, Moran CJ. A review of technological innovations leading to modern endovascular brain aneurysm treatment. Front Neurol 2023; 14:1156887. [PMID: 37114225 PMCID: PMC10126349 DOI: 10.3389/fneur.2023.1156887] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
Tools and techniques utilized in endovascular brain aneurysm treatment have undergone rapid evolution in recent decades. These technique and device-level innovations have allowed for treatment of highly complex intracranial aneurysms and improved patient outcomes. We review the major innovations within neurointervention that have led to the current state of brain aneurysm treatment.
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Affiliation(s)
- David C. Lauzier
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- *Correspondence: David C. Lauzier ;
| | - Anna L. Huguenard
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Anja I. Srienc
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Samuel J. Cler
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Joshua W. Osbun
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Arindam R. Chatterjee
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Ananth K. Vellimana
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Akash P. Kansagra
- Department of Neurointerventional Surgery, California Center of Neurointerventional Surgery, San Diego, CA, United States
| | - Colin P. Derdeyn
- Department of Radiology, University of Iowa School of Medicine, Iowa City, IA, United States
| | - Dewitte T. Cross
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Christopher J. Moran
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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7
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Pierot L, Szikora I, Barreau X, Holtmannspoetter M, Spelle L, Klisch J, Herbreteau D, Costalat V, Fiehler J, Januel AC, Liebig T, Stockx L, Weber W, Berkefeld J, Moret J, Molyneux A, Byrne J. Aneurysm treatment with the Woven EndoBridge (WEB) device in the combined population of two prospective, multicenter series: 5-year follow-up. J Neurointerv Surg 2022; 15:552-557. [PMID: 35803731 DOI: 10.1136/neurintsurg-2021-018414] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/28/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Evaluating a new endovascular treatment for intracranial aneurysms must not only demonstrate short-term safety and efficacy, but also evaluate longer-term outcomes (eg, delayed complications, anatomical results, retreatment). The current analysis reports the 5-year clinical and anatomical results of Woven EndoBridge (WEB) treatment in two European combined trial populations (WEBCAST (WEB Clinical Assessment of Intrasaccular Aneurysm Therapy) and WEBCAST-2). METHODS All adverse events occurring between the procedure and 5-year follow-up were independently evaluated by an expert. Aneurysm occlusion was evaluated by an independent core laboratory using a three-grade scale: complete occlusion, neck remnant, and aneurysm remnant. In cases where data were not available at 5-year follow-up, the last observation carry forward (LOCF) method was used. RESULTS The safety and efficacy populations comprised 100 patients and 95 aneurysms, respectively. No adverse event related to the device occurred after the procedure during the 5-year follow-up period. Mortality at 5 years was 7.0% (7/100 patients) including mortality related to the WEB (0/100, 0.0%), the procedure (1/100, 1.0%), and another condition (6/100, 6.0%). At 5 years, complete aneurysm occlusion was observed in 49/95 (51.6%) aneurysms, neck remnant in 25/95 (26.3%), and aneurysm remnant in 21/95 (22.1%). Retreatment rate at 5 years was 11.6% (11/95 aneurysms). CONCLUSIONS This analysis conducted in a population of patients with wide-neck bifurcation aneurysms confirms WEB's safety profile. Additional evidence demonstrates good stability of aneurysm occlusion with adequate occlusion (complete occlusion or neck remnant) at 5 years in 77.9% of aneurysms with a low retreatment rate (11.6%). CLINICAL TRIAL REGISTRATION WEBCAST and WEBCAST-2: Unique identifier: NCT01778322.
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Affiliation(s)
- Laurent Pierot
- Department of Neuroradiology, CHU Reims, Reims, Champagne-Ardenne, France
| | - Istvan Szikora
- Neurointerventions, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Xavier Barreau
- Neuroradiology Department, CHU Bordeaux GH Pellegrin, Bordeaux, Aquitaine, France
| | - Markus Holtmannspoetter
- Interventional and Diagnostic Neuroradiology, Nuremberg Hospital Campus South, Nurnberg, Germany
| | - Laurent Spelle
- NEURI Interventional Neuroradiology, APHP, Paris, Île-de-France, France.,Neuroradiology, Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Joachim Klisch
- Neuroradiology, Helios Klinikum Erfurt, Erfurt, Thüringen, Germany
| | | | - Vincent Costalat
- Neuroradiology, CHU Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Thomas Liebig
- Department of Neuroradiology, University Hospital Munich, Munchen, Bayern, Germany
| | - Luc Stockx
- Neuroradiology, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium
| | - Werner Weber
- Radiology and Neuroradiology, Ruhr-Universität Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Joachim Berkefeld
- Institute of Neuroradiology, Goethe-Universitat Frankfurt am Main, Frankfurt am Main, Hessen, Germany
| | - Jacques Moret
- NEURI Interventional Neuroradiology, APHP, Paris, Île-de-France, France
| | - Andy Molyneux
- Neurovascular and Neuroradiology Research Unit, Oxford University, Oxford, UK
| | - James Byrne
- Department of Neuroradiology, Oxford University, Oxford, UK
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8
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Huber M, Luedi MM, Andereggen L. Commentary: Automated Machine Learning Model Development for Intracranial Aneurysm Treatment Outcome Prediction: A Feasibility Study. Front Neurol 2022; 13:878091. [PMID: 35756931 PMCID: PMC9226472 DOI: 10.3389/fneur.2022.878091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Markus Huber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Andereggen
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.,Faculty of Medicine, University of Bern, Bern, Switzerland
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Laurent D, Lucke-Wold B, Dodd WS, Martinez M, Chowdhury MAB, Hosaka K, Motwani K, Hoh B. Combination release of chemokines from coated coils to target aneurysm healing. J Neurointerv Surg 2022:neurintsurg-2022-018710. [PMID: 35609975 PMCID: PMC10116990 DOI: 10.1136/neurintsurg-2022-018710] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Monocyte chemoattractant protein 1 (MCP-1) and osteopontin (OPN) have been identified separately as key mediators of the aneurysm healing process following coil embolization in the rodent model. The ability of protein coated coils to accelerate this process is currently unknown.To create coils coated with both MCP-1 and OPN to target aneurysm healing. METHODS We uses a polymer (poly(glycolide-co-caprolactone)) (Rao pharmaceuticals) (CG910) to test whether coils could be dual coated with active proteins with sequential reliable release. Coils were coated with poly-DL-lactic glycolic acid (PLGA), CG910, and subsequently dipped with protein OPN (inner layer for delayed release) and MCP-1 (outer layer for initial release). Release assays were used to measure protein elution from coils over time. To test in vivo feasibility, coated coils were implanted into carotid aneurysms to determine the effect on aneurysm healing. RESULTS The in vitro protein release assay demonstrated, a significant amount of OPN and MCP-1 release within 2 days. Using a 200 µg/µL solution of MCP-1 in phosphate-buffered saline, we showed that CG910 coated coils provide effective release of MCP over time. In the carotid aneurysm model, MCP-1 and OPN coated coils significantly increased tissue ingrowth (74% and 80%) compared with PLGA and CG910 coated coils alone (58% and 53%). To determine synergistic impact of dual coating, we measured ingrowth for MCP-1/OPN coils (63%) as well as overlap coefficients for NOX4 and NFκB with CD31. CONCLUSIONS This study demonstrates that MCP-1 and OPN coated coils are viable and may promote early aneurysm healing. Dual coated coils may have synergistic benefit given different location of protein interaction measured in vivo. Further work is warranted.
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Affiliation(s)
- Dimitri Laurent
- Lillian S Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Brandon Lucke-Wold
- Lillian S Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - William S Dodd
- Lillian S Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Melanie Martinez
- Lillian S Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | | | - Koji Hosaka
- Lillian S Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Kartik Motwani
- Lillian S Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Brian Hoh
- Lillian S Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
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Laurent D, Lucke-Wold B, Leary O, Randall MH, Porche K, Koch M, Chalouhi N, Polifka A, Hoh BL. The Evolution of Endovascular Therapy for Intracranial Aneurysms: Historical Perspective and Next Frontiers. Neurosci Insights 2022; 17:26331055221117560. [PMID: 35924091 PMCID: PMC9340900 DOI: 10.1177/26331055221117560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/18/2022] [Indexed: 11/20/2022] Open
Abstract
The history of cerebral aneurysm treatment has a rich and storied past with multiple notable luminaries contributing insights. The modern era has transitioned from primarily clip ligation to increasing use of endovascular therapy. Even more recently, the use of intrasaccular flow diverters has been introduced for the treatment of wide necked aneurysms. The field is continuing to transform, and bioactive coils and stents have resurfaced as promising adjuvants to promote aneurysm healing. Advanced imaging modalities are being developed that could further advance the endovascular arsenal and allow for porous memory polymer devices to enter the field. This focused review highlights notable historic contributions and advances to the point of futuristic technology that is actively being developed.
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Affiliation(s)
- Dimitri Laurent
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | | | - Owen Leary
- Department of Neurosurgery, Brown University, Providence, RI, USA
| | - Morgan H Randall
- Department of Cardiology, University of Florida, Gainesville, FL, USA
| | - Ken Porche
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock AR, USA
| | - Matthew Koch
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock AR, USA
| | - Nohra Chalouhi
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock AR, USA
| | - Adam Polifka
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock AR, USA
| | - Brian L Hoh
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock AR, USA
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Belavadi R, Gudigopuram SVR, Raguthu CC, Gajjela H, Kela I, Kakarala CL, Hassan M, Sange I. Surgical Clipping Versus Endovascular Coiling in the Management of Intracranial Aneurysms. Cureus 2021; 13:e20478. [PMID: 35047297 PMCID: PMC8760002 DOI: 10.7759/cureus.20478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 01/16/2023] Open
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12
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Zhao R, Duan G, Yang P, Li T, Guan S, Yang H, Zhao Z, Zhu X, Liang G, Wu X, Leng B, Wang Y, Wu Y, Zuo Q, Zhang L, Li Z, Zhou Y, Zhao K, Dai D, Fang Y, Li Q, Huang Q, Hong B, Xu Y, Liu J. Endovascular aneurysm treatment with the Numen coil embolization system: A prospective, randomized, controlled, open-label, multi-center, non-inferiority trial in China. World Neurosurg 2021; 160:e23-e32. [PMID: 34906756 DOI: 10.1016/j.wneu.2021.11.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES We investigated the safety and efficacy of the Numen coil in comparison to the Axium coil in the treatment of intracranial aneurysms. METHODS As CATCH is a prospective, randomized, controlled, open-label, non-inferiority trial conducted in ten centers across China, subjects who fulfilled the inclusion and exclusion criteria were randomized 1:1 to either a test group (Numen) or a control group (Axium). The primary outcome was based upon the successful aneurysm occlusion at the six-month follow-up, while secondary outcomes included technical success, the recanalization and retreatment rates, the rate of serious adverse events (SAE) at the six-month and 12-month follow-up. RESULTS Between August 2017-December 2019, a total of 350 subjects presenting with 350 aneurysms were enrolled and randomized. Per-protocol analysis revealed that the successful aneurysm occlusion rate at six months was 91.18% for the test group as compared to 91.85% in the control group, with a difference of -0.68% (p = 0.8419), while the overall mortality rates during the 30-day follow-up period were 1.19% and 1.81% in the test and control group, respectively showing no significant difference between the two groups (p = 0.6837) whereas the SAEs incidence during the 12-month follow-up period was 12.50% and 17.47% in the test and control group, respectively which was not statistically significant (p = 0.2222). CONCLUSION This trial demonstrated that the Numen coil was non-inferior to the Axium coil in terms of intracranial aneurysm embolization and can be considered as a safe and effective coils for treating intracranial aneurysm patients in clinical practice.
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Affiliation(s)
- Rui Zhao
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Guoli Duan
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Pengfei Yang
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Tianxiao Li
- Department of Interventional radiology, Henan Provincial People's hospita, Weiwu Road 7#, Zhengzhou municipality, Henan Province
| | - Sheng Guan
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou Universit, Longhu middle ring road 1#, Jinshui District, Zhengzhou City, Henan Province
| | - Hua Yang
- Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyi street 28#, Yunyan District, Guiyang City, Guizhou Province
| | - Zhenwei Zhao
- Department of Neurosurgery, Tangdu Hospital Affiliated to Fourth Military Medical University, Xinsi Road 1#, Baqiao District, Xi'an City, Shaanxi Province
| | - Xingen Zhu
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Minde Road 1#, Nanchang City, Jiangxi Province
| | - Guobiao Liang
- Department of Neurosurgery, The General Hospital of Shenyang military, Wenhua Road 83#, Shenhe district,Shenyang Province (Guobiao Liang)
| | - Xin Wu
- Department of Neurosurgery, Yantai Yuhuangding hospital, Yuhuangding East Road 20#, Zhifu District, Yantai City, Shandong Province
| | - Bing Leng
- Department of Neurosurgery, Huashan hospital, Middle Wulumuqi Road 12#, Shanghai, China(Bing Leng)
| | - Yang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Yongwai Main Street 12#, Nanchang City, Jiangxi Province
| | - Yina Wu
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Qiao Zuo
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Lei Zhang
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - ZiFu Li
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Yu Zhou
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Kaijun Zhao
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Dongwei Dai
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Yibin Fang
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Qiang Li
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Qinghai Huang
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Bo Hong
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Yi Xu
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168#, Shanghai, China;.
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Benomar A, Farzin B, Volders D, Gevry G, Zehr J, Fahed R, Boisseau W, Gentric JC, Magro E, Nico L, Roy D, Weill A, Mounayer C, Guilbert F, Létourneau-Guillon L, Jacquin G, Chaalala C, Kotowski M, Nguyen TN, Kallmes D, White P, Darsaut TE, Raymond J. Angiographic results of surgical or endovascular treatment of intracranial aneurysms: a systematic review and inter-observer reliability study. Neuroradiology 2021; 63:1511-9. [PMID: 33625550 DOI: 10.1007/s00234-021-02676-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/15/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Results of surgical or endovascular treatment of intracranial aneurysms are often assessed using angiography. A reliable method to report results irrespective of treatment modality is needed to enable comparisons. Our goals were to systematically review existing classification systems, and to propose a 3-point classification applicable to both treatments and assess its reliability. METHODS We conducted two systematic reviews on classification systems of angiographic results after clipping or coiling to select a simple 3-category scale that could apply to both treatments. We then circulated an electronic portfolio of angiograms of clipped (n=30) or coiled (n=30) aneurysms, and asked raters to evaluate the degree of occlusion using this scale. Raters were also asked to choose an appropriate follow-up management for each patient based on the degree of occlusion. Agreement was assessed using Krippendorff's α statistics (αK), and relationship between occlusion grade and clinical management was analyzed using Fisher's exact and Cramer's V tests. RESULTS The systematic reviews found 70 different grading scales with heterogeneous reliability (kappa values from 0.12 to 1.00). The 60-patient portfolio was independently evaluated by 19 raters of diverse backgrounds (neurosurgery, radiology, and neurology) and experience. There was substantial agreement (αK=0.76, 95%CI, 0.67-0.83) between raters, regardless of background, experience, or treatment used. Intra-rater agreement ranged from moderate to almost perfect. A strong relationship was found between angiographic grades and management decisions (Cramer's V: 0.80±0.12). CONCLUSION A simple 3-point scale demonstrated sufficient reliability to be used in reporting aneurysm treatments or in evaluating treatment results in comparative randomized trials.
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