Polyglycolide/Polylactide-Coated Platinum Coils for Patients With Ruptured and Unruptured Cerebral Aneurysms

Abstract

Background and Purpose— Recanalization of cerebral aneurysm is a limitation of bare platinum coils (BPCs). In a swine aneurysm model, polyglycolide/polylactide (a polymer)-coated platinum coils (Matrix) accelerated clot fibrosis and reduced recanalization rate and aneurysmal volume. We aimed to evaluate the safety of Matrix coils in patients with intracranial aneurysm. Methods— This is a single-center, prospective study of patients with intracranial aneurysms treated with Matrix alone or in combination with BPCs. Follow-up evaluation included a 1-month clinical evaluation and a 6- and 12-month clinical and angiographic examination. Primary adverse events included death, stroke, and permanent neurological deficits. Results— Between May 2002 and January 2004, 52 patients (range 34 to 79 years of age; 38 females) were treated for 54 aneurysms (size 7.9±4.6 mm; neck 3.9±1.5 mm; 26 ruptured). Matrix alone was used in 13 aneurysms. In 39, we used a combination of Matrix and BPCs. Twenty-one aneurysms had a 6-month follow-up examination (11 Matrix; 10 Matrix combined with bare platinum), and 11 completed the 12-month follow-up evaluation (Matrix only). Adverse events not related to the procedure were 2 deaths (ruptured basilar aneurysms) and 1 stroke at day 10 postcoiling secondary to vasospasm. Procedure-related adverse events were 2 strokes. At 6-month follow-up (n=21) evaluation, 2 of 3 recanalizations needed retreatment. At 12-month follow-up (n=11), there was no recanalization in patients treated with Matrix alone and no significant reduction in aneurysmal size. Conclusions— Polyglycolide/polylactide-coated coils had a satisfactory safety profile. Significant aneurysmal size reduction after coiling was not observed.

Endovascular Coiling of Cerebral Aneurysms Using “Bioactive” or Coated-Coil Technologies: A Systematic Review of the Literature

“…The sensitivity of the electronic search strategy was 97% (it identified 31/32 studies). Of these studies, 15 were on Matrix (PGLA-coated coils from Boston Scientific, Natick, Mass), [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] 11 were on hydrogel-coated coils (HydroCoil embolic system; MicroVention, Aliso Viejo, Calif), 27-37 1 was on both hydrogel and Matrix, 38 2 were on Sapphire fibered coils (ev3, Irvine, Calif), 39,40 and 3 were on Cerecyte (PGA-coated coils; Micrus, Sunnyvale, Calif). [41][42][43] The study on PGLA-and hydrogel-coated coils was excluded because it was impossible to separate information on the 2 coil types from bare platinum data, let alone from each other; thus in terms of results by coated coil, it was impossible to assess.…”

Complex-Shaped Platinum Coils for Brain Aneurysms: Higher Packing Density, Improved Biomechanical Stability, and Midterm Angiographic Outcome

“…36 Thus, aneurysm volume calculations based on 3D-rotational angiography remain of an investigational nature. On the other hand, the method used to calculate the aneurysm volume in this study has been applied in numerous series, 15,17,25,27,31,38,39 thus allowing comparisons to be made because common methods were used.…”

“…Although the data originated from small, single-center case series, they showed that packing of more than 20%-25% resulted in lower rates of coil compaction. 27,[31][32][33][34] In a larger study, Sluzewski et al 8 retrospectively reviewed 160 patients with aneurysmal SAH and followed patients up to 6 and 18 months after coil placement. The authors reported that the relative risk factors for aneurysmal recanalization at 6 months were the age of the patient, aneurysm size Ն15 mm, and aneurysm location in the posterior circulation.…”

Coil Type Does Not Affect Angiographic Follow-Up Outcomes of Cerebral Aneurysm Coiling: A Systematic Review and Meta-Analysis

“…1 In an effort to improve long-term occlusion rates, a number of "modified," second-generation coil types have been developed and marketed. Numerous single-center case series have been published regarding outcomes for each of these second-generation coil types, including Matrix (Boston Scientific, Natick, Massachusetts), [2][3][4] HydroCoil (MicroVention, Tustin, California), [5][6][7] and Cerecyte coils (Codman Neurovascular, Raynham, Massachusetts). 8,9 In addition, outcomes from several randomized, controlled trials (RCTs) of the major coil types have recently been reported.…”