A single centre study of coil embolization of intracranial aneurysms comparing bare platinum and PGLA-coated coils

Abstract

There is no robust consensus on the efficacy of polyglycolic/polylactic acid (PGLA)-coated coils used in the endovascular embolization of intracranial aneurysms. We present a comparative study of bare platinum coils and PGLA-coated Gugliemi Detachable Coils (GDC) in the treatment of intracranial aneurysms at a single centre, using target aneurysm recurrence and angiographic recanalization as the primary endpoints. We included all patients treated between 1998 and 2009 who had undergone at least one angiographic post-procedural follow-up. Patient demographics, clinical presentation, operative notes, and all relevant imaging were collected. Of the 441 aneurysms with follow-up, 290 were treated with at least one PGLA coil and 151 aneurysms were treated exclusively with bare platinum coils. At follow-up, 26.5% of platinum controls demonstrated angiographic recanalization, compared to 31.4% of PGLA-treated aneurysms ( p = 0.002). PGLA-treated aneurysms were more likely to have an angiographic remnant at follow-up (odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.26–3.04, p = 0.003). The post-operative Raymond score was the only predictor of retreatment (OR = 1.6, 95% CI = 1.08–2.24, p = 0.020), and was the second strongest predictor of a complete angiographic result at follow-up (OR = 1.67, 95% CI = 1.22–2.27, p = 0.001). We concluded that PGLA-coated coils demonstrated poorer post-operative and long-term angiographic occlusion in the treatment of intracranial aneurysms, compared to bare platinum coils.