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Neuroscience: Intracranial Aneurysm Recurrence Less Likely with Coated Coil Treatment

Hydrogel outperformed bare platinum coil

Intracranial aneurysms treated with hydrogel-coated coils are less likely to recur than those treated with bare platinum coils, according to the results of a study published recently in the Lancet.

Prior research showed endovascular coiling to be superior to neurosurgical clipping for the treatment of intracranial aneurysms. Although clipping is more invasive, retreatment is more often necessary with coiling. Data on the best types of coils are therefore helpful, but lacking. Coated coils have been available for several years, but little evidence existed on their safety and effectiveness. The authors of the current study sought to compare outcomes with hydrogel-coated and bare platinum coils.

Between September 13, 2004 and February 21, 2007, they randomized patients aged 18 to 75 years with an untreated ruptured or unruptured cerebral aneurysm of two to 25 mm to hydrogel-coated or bare coil treatment. The trial was undertaken at 24 centers in seven countries (United Kingdom, United States, Brazil, Germany, Australia, France, and Argentina). All participants had one aneurysm that was judged to need coiling, a World Federation of Neurosurgeons grading between zero and three, and anatomy such that occlusion was considered possible. Pregnant patients were excluded from analysis.

After about 18 months of follow-up, 8.6 percent fewer patients who were treated with hydrogel-coated coils had a major recurrence. Hydrogel coils were more effective for acutely ruptured aneurysms as well. Overall, however, there weren’t significant differences between the two groups in terms of death, dependency, or clinical status. The authors concluded that hydrogel coils may be a better bet, but that more research is necessary.

Source: White PM, Lewis SC, Gholkar A, et al. 2011. Hydrogel-coated coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms (HELPS): a randomised controlled trial. Lancet 377:1655-1662.