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reduced performance. 10 However, the addition of complex 360°s hapes improved the angiographic outcomes for both Matrix and GDC coils-making the 2 more comparable.In a detailed analysis, the actual benefit of Matrix surface modification was in the histopathologic results, which showed that Matrix-treated aneurysms showed improved endothelization, manifest as an absence of endothelialized clefts at the aneurysm neck (which are prevalent in GDC-treated aneurysms). 10 Endothelialized clefts have been proposed as the etiology for late angiographic recurrences. 5 Late recurrences have been reported at 3 years in up to 15% of aneurysms that had been completely occluded acutely and in short-term follow-up. 11 While the MAPS trial showed that in the short term, Matrix was essentially equivalent to platinum coils, the real benefits of surface modification may be manifest in the results at late (3-and 5-year) follow-up.Furthermore, in subgroup analysis, when aneurysms were adequately occluded (Raymond-Roy scale 1 or 2), Matrix had significantly better outcomes with only 2.7% requiring retreatment compared with 9.6% (P ϭ .01) with platinum coils. 12 However, aneurysms with residual flow (Raymond-Roy scale 3) demonstrated poor outcomes in both arms-Matrix (24.2%) and platinum (16.1%) (P ϭ .17). These observations coincide well with the known polyglycolic/polylactic acid (PGLA) characteristics, the polymer coating on Matrix coils. When exposed to high-flow states, PGLA experiences an acceleration of breakdown, nullifying any potential gain due to the bioactive component of the coil. These results suggest that the short-term issues with Matrix were more likely related to the adequacy of mechanical occlusion rather than the efficacy of the bioactive coating.We believe that collaborative doctor/industry relationships are an important synergistic dynamic that is essential for continued technologic advancement in our specialty. It is critical that high standards be set for new technologies, particularly for those designed to treat diseases with well-established safe therapies. Regimented postmarket data collection and evaluation should occur with all new technologies, ensuring that marketing claims are not confused with scientific evidence. 13 However, to mix concerns with technology marketing or limitations in the implementation of a technology with a perception of failure of the fundamental scientific premise would be a mistake.In our opinion, the concept of platinum coil surface modification to stabilize or increase the rate of thrombus organization is still valid and continues to have promise for enhancing long-term aneurysm occlusion stability. Time will tell whether this benefit will be reflected in the late-term MAPS data; the current data do not negate the fundamental concepts of bioactive coatings. As such, continued innovation toward the development of better delivery mechanisms or more durable bioactive responses is entirely reasonable.

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