Perioperative safety of Hydrosoft coils

ArticleinJournal of Neurointerventional Surgery 4(5):375-8 · October 2011with3 Reads
DOI: 10.1136/neurintsurg-2011-010106 · Source: PubMed
Abstract
Hydrosoft coils were developed to serve as finishing coils to prevent aneurysmal recurrence at the neck. Initial animal studies were encouraging since some studies showed endothelial healing across the neck without recurrence over time. However, theoretical concerns exist regarding the potential threat to parent vessels as the Hydrosoft coils at the neck expand, as well as whether such coils can be adequately supple to safely serve as a true finishing coil. A retrospective review of the initial clinical experience utilizing Hydrosoft coils from three high-volume centers was performed. Each center was asked to report angiographic (aneurysmal location, aneurysmal maximal size, neck size, incidence of intraprocedural parent vessel thrombosis, coil herniation, aneurysmal rupture as well as Raymond scale and percent occlusion after coiling) and clinical (rupture status, Hunt and Hess grade, incidence of stroke, hemorrhage, vasospasm and hydrocephalus) data on consecutive patients who underwent placement of Hydrosoft coils. A total of 141 patients were enrolled. Embolization achieved a Raymond scale score of I (complete obliteration) in 79 aneurysms (56%), II (residual neck) in 40 aneurysms (28%) and III (residual dome) in 21 aneurysms (15%); in one case the Hydrosoft coil could not be placed. Procedural morbidity and mortality were 2.1% and 1.4%, respectively. No complications were definitively attributed to the use of Hydrosoft coils. There were three cases (2.1%) of parent vessel thrombosis, two of which resolved after intraprocedural administration of thrombolytic agents and did not lead to neurological sequelae. The incidences of intraprocedural or periprocedural aneurysmal rupture (2.1%), cerebral hemorrhage (3.5%), stroke (4.9%), vasospasm (26.2%) or hydrocephalus (31.1%) were comparable to contemporary literature. The use of Hydrosoft coils appears to be safe and does not lead to higher complication rates than are currently accepted in the literature. Further prospective studies are required to determine whether the use of Hydrosoft coils results in a lower incidence of aneurysmal recurrence.
    • "The effectiveness of a hybrid hydrogel platinum detachable coil (HydroCoil, MicroVention Inc., Tustin, CA) for endovascular aneurysm treatment has been proven in a recently published randomized controlled trial [3]. Due to technical restrictions (coil stiffness, time restriction for placement ), the HydroSoft coil as well as a corresponding 3D framing coil, the HydroFrame coil (MicroVention Inc., Tustin, CA), a class of new softer coils containing less hydrogel and swelling more slowly than the HydroCoil, have been developed and brought to clinical practice45678. A recently published multicentre study retrospectively compared 401 patients harbouring 430 intracranial aneurysms treated with endovascular coil embolization with HydroSoft coils with a control group of 221 patients harbouring 253 aneurysms that underwent coil embolization with bare platinum coils [9]. "
    [Show abstract] [Hide abstract] ABSTRACT: The effectiveness of a hybrid hydrogel platinum detachable coil (HydroCoil; MicroVention Inc., Tustin, CA) for endovascular aneurysm treatment has been proven in a recently published RCT. Due to technical restrictions (coil stiffness, time restriction for placement), the HydroSoft coil as well as a corresponding 3D framing coil, the HydroFrame coil (MicroVention Inc., Tustin, CA), a class of new softer coils containing less hydrogel and swelling more slowly than the HydroCoil, have been developed and brought to clinical practice. The present study aims to compare the effectiveness of endovascular aneurysm treatment with coil embolization between patients allocated HydroSoft/HydroFrame versus bare platinum coiling. GREAT is a randomized, controlled, multicentre trial in patients bearing cerebral aneurysms to be treated by coil embolization. Eligible patients were randomized to either coil embolization with HydroSoft/HydroFrame coils (>50 % of administered coil length), or bare platinum coils. Inclusion criteria were as follows: age 18-75, ruptured aneurysm (WFNS 1-3) and unruptured aneurysm with a diameter between 4 and 12 mm. Anatomy such that endovascular coil occlusion deemed possible and willingness of the neurointerventionalist to use either HydroSoft/HydroFrame or bare platinum coils. Exclusion criteria were as follows: aneurysms previously treated by coiling or clipping. Primary endpoint is a composite of major aneurysm recurrence on follow-up angiography and poor clinical outcome (modified Rankin scale 3 or higher), both assessed at 18 months post treatment. Risk differences for poor outcomes will be estimated in a modified intention-to-treat analysis stratified by rupture status (DRKS-ID: DRKS00003132).
    Full-text · Article · Feb 2015
    • "In addition, the HydroSoft coil does not require prehydration for softening, and there is virtually no time limitation for deployment after it is exposed to blood. HydroSoft is extremely gentle in treating smaller aneurysm or deployed as final coils near the neck of an aneurysm31323334 and can complement the HydroCoil system for challenges, such as resistance or microcatheter instability. We used HydroSoft coils both as framing, filling, and finishing coils in selected cases. "
    [Show abstract] [Hide abstract] ABSTRACT: To evaluate the perioperative safety and mid-term prognosis (≤12 months) of HydroSoft coils in treating ruptured aneurysms at the anterior circulation compared with bare platinum coils. Patients with aneurysmal subarachnoid hemorrhages admitted to our hospital between January 2009 and March 2012 were retrospectively analyzed. According to strict inclusion and exclusion criteria, cases were selected and classified into two groups: In group A, HydroSoft coils were used as the primary filling coils (≥40 % of total coil length); in group B, only bare platinum coils were used. Cases in both groups were all treated with stent-assistance. A comparison between the two groups was performed for periprocedural complications as well as immediate and mid-term outcomes. The stents used included Enterprise, Neuroform, and Solitaire. Fifty-six aneurysms were in group A patients, and 68 aneurysms were in group B patients. Compared with group B, group A did not have increased incidence of complications but had greater packing attenuation (44.5 ± 8.8-29.8 ± 9.1 %, t = 2.577, P = 0.014) and increased initial complete occlusion rates (63-44 %, χ (2) = 4.161, P = 0.041). Radiologic follow-up were performed in 46 patients from group A and 51 patients from group B. Complete occlusion rates at follow-up were significantly greater in group A than in group B (89.1-70.6 %, χ (2) = 5.08, P = 0.043); the difference in recanalization rates were statistically insignificant between the groups (6.5-5.9 %, P = 1.000). HydroSoft coils proved safe during the periprocedural period and provided greater initial complete occlusion rates, greater packing density, and better follow-up results compared with bare platinum coils.
    Article · Nov 2013
    Che JiangChe JiangYing YuYing YuBo HongBo Hong+1more author...[...]
  • [Show abstract] [Hide abstract] ABSTRACT: The treatment of intracranial aneurysms has undergone precipitous expansion since the first detachable coils were used less than two decades ago. With rapidly expanding technology comes the need to keep all involved parties informed. The objective of our review is to provide a comprehensive, succinct overview of novel paradigms and devices used to treat intracranial aneurysms. We have divided these new technologies into: (1) coils, (2) flow diverters, (3) adjunctive balloon devices, and (4) stents.
    Article · Feb 2014
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