Abstract
BackgroundDue to uniform stiffness of standard platinum coils, dense packing of intracranial aneurysms can be difficult to achieve, since stiffer coils can cause microcatheter prolapse or coil migration. SMART coils have a varying softness along the length of the coils to improve deliverability. We report our initial 2 year experience with the SMART coil system, including direct and follow-up results.MethodsWe performed a retrospective study of all patients who underwent coil embolization of an intracranial aneurysm with SMART coils between July 2016 and August 2018 at our institution. We analyzed clinical and angiographic data before and directly after treatment as well as at 6 months follow-up.ResultsA total of 49 patients harboring 49 aneurysms were treated; 23 (47%) were ruptured aneurysms. Most aneurysms (57%) were located in the anterior circulation. Median patient age was 55 (31–88), 63% were female. Mean aneurysm size was: neck 3.4 (±1.5), height 6.3 (±2.9) and width 5.2 (±2.3) mm. SMART coils were solely used in 96% of cases. Initial favorable angiographic results were achieved in 45 (92%) of 49 cases, which were stable at 6 months in 26/29 (90%). Thromboembolic complications occurred in 4 (8%) cases without clinical sequelae; microcatheter prolapse occurred in 1 case. No aneurysm rupture or device malfunction was observed.ConclusionThe treatment of ruptured and unruptured intracranial aneurysms with SMART Coils was safe and efficacious in our cohort.
Highlights
Due to uniform stiffness of standard platinum coils, dense packing of intracranial aneurysms can be difficult to achieve, since stiffer coils can cause microcatheter prolapse or coil migration
A total of 49 patients harboring 49 aneurysms were treated with SMART Coils between July 2016 and August 2018
Eight out of forty nine (16%) patients were harboring at least one additional aneurysm; none of these was treated at the time of treatment with SMART coils
Summary
Due to uniform stiffness of standard platinum coils, dense packing of intracranial aneurysms can be difficult to achieve, since stiffer coils can cause microcatheter prolapse or coil migration. Only a few of the novel techniques have been investigated in prospective trials [1, 2]. Utilization, complications and outcomes have to be investigated to determine the safety and efficacy of new devices. A relatively new device to treat IAs is the SMART coil (Penumbra Inc., Alameda, CA, USA). This hybrid coil becomes progressively softer from its distal to its proximal end and should allow easier deployment with a more stable microcatheter positioning compared to standard coils with a uniform stiffness. SMART coils have a stretch resistant platform, which promises more safety while the coils are placed or
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