Coil Group Research Articles

Thromboembolic Events Associated with Electrolytic Detachment of Guglielmi Detachable Coils and Target Coils : Comparison with Use of Diffusion-Weighted MR Imaging

ObjectiveThe purpose of this study was to retrospectively evaluate and compare the incidence of diffusion-weighted image (DWI) lesions between the Guglielmi detachable coil (GDC) and the Target coil for treating unruptured intracranial aneurysm.MethodsFrom 2010 to 2011, consecutive 222 patients with an intracranial aneurysm underwent coil embolization. Inclusion criterias were : 1) unruptured intracranial aneurysm, 2) one or more GDC or Target coils used with or without other coils, 3) DWI examination within 24 hours after coiling, and 4) coiling performed without a balloon or stent.ResultsNinety patients (92 cases) met the inclusion criteria. DWI lesions were detected in 55 (61.1%) of 90 patients. In the GDC group (n=44), DWI lesions were detected in 31 (70.5%). The average number of DWI lesions was 5.0±8.7 (mean±SD; range, 1-40) in aneurysm-related territory. In the Target coil group (n=48), DWI lesions were detected in 24 (50.0%). The number of DWI lesion was 2.1±5.4 (range, 1-32) in aneurysm-related territory. There was no significant correlation between a number of coils and DWI lesions. No significant differences were also observed in the number of DWI lesions in each group.ConclusionThe GDC and Target coils, which have an electrolytic detachable system, showed no differences in the incidence of DWI lesion.

Basilar Tip Aneurysms

Endovascular therapy has largely replaced microsurgical clipping for the treatment of basilar tip aneurysms. We describe the variables our center evaluates when choosing to clip or coil basilar tip aneurysms and our outcomes. Four case illustrations are presented. All patients with ruptured or unruptured basilar tip aneurysms from 2005 to April 2012 were examined. The patients were treated by 2 interventional neuroradiologists and 2 dually trained neurosurgeons. There were 63 ruptured (clipped 38%, coiled 62%) and 37 unruptured (clipped 35%, coiled 65%) aneurysms in this 100-patient study. Seventy percent of the patients with ruptured aneurysms and 92% of the patients with unruptured aneurysms had a good outcome (modified Rankin scale 0-2) at 3 months. For ruptured aneurysms, there was a statistically significant difference in clipping and coiling with respect to age and treatment modality (clip 48.8 years, coil 57.6 years). Patients in the coiled group had higher dome-to-neck (1.3 vs 1.1) (P = .01) and aspect ratios (1.6 vs 1.2) (P = .007). In the ruptured coiling group, 69.5% achieved a Raymond 1 radiographic outcome, 28% Raymond 2, and 2.5% Raymond 3. Eleven (17.4%) patients required re-treatment, and 3 (4.4%) patients were re-treated more than twice. Coiling of unruptured aneurysms resulted in 75% Raymond 1. There were no residual lesions for unruptured clipped aneurysms. There were no differences in outcome between clipping and coiling in the ruptured and unruptured group. In our current management of basilar tip aneurysms, the majority can be treated via endovascular means, albeit with the expectation of a higher percentage of residual lesions and recurrences. Microsurgery is still appropriate for aneurysms with complex neck morphologies and in young patients desiring a more durable treatment.

Subarachnoid haemorrhage (SAH): long-term cognitive outcome in patients treated with surgical clipping or endovascular coiling

Purpose: To compare long-term cognitive outcomes of patients treated with surgical clipping or endovascular coiling after subarachnoid haemorrhage (SAH). Method: Retrospective matched cohort study assessed neuropsychological functioning at least 12 months after aneurysmal SAH treatment. Fourteen patients treated by endovascular coiling and nine patients treated by surgical clipping participated. After gaining written consent, a comprehensive neuropsychological battery was completed. Standardised tests were employed to assess pre-morbid and current intellectual functioning (IQ), attention, speed of information processing, memory and executive function as well as psychosocial functioning and affect. Results: Treatment groups were not significantly different in terms of age, pre-morbid IQ, time from injury to treatment or time since injury. A significant effect of treatment on full-scale IQ score (p = 0.025), performance IQ (p = 0.045) and verbal IQ score (p = 0.029), all favouring the coiled group was observed. A medium effect size between groups difference in immediate memory (p = 0.19, partial η2 = 0.08) was also observed. No significant between group differences on attention, executive functioning and speed of information processing measures or mood and psychosocial functioning were noted. Both groups reported increased anxiety and memory, attention and speed of information processing deficits relative to normative data. Conclusions: Study findings indicate fewer cognitive deficits following endovascular coiling. Cognitive deficits in the clipped group may be due in part to the invasive nature of neurosurgical clipping. Further prospective research with regard to long-term cognitive and emotional outcomes is warranted.Implications of RehabilitationTreatment of ruptured intracranial aneurysms by either endovascualar coiling or neurosurgical clipping can result in significant long-term physical disability as well as cognitive impairment.Observed cognitive impairment(s) tend to be less in patients following endovascular coiling.Following ruptured aneurysm, patients with cognitive impairment report reduced health related quality of life and increased anxiety.Those with identified cognitive impairment(s) may benefit from cognitive remediation.

O-012 Long term angiographic follow-up of aneurysms treated with self-expandable stents

PurposeStent-assisted coiling of intracranial aneurysms has proved to promote aneurysm occlusion and to reduce aneurysm recurrence. First reports were promising but longer follow-up are needed to confirm the benefits of...

P-047 Aneurismal thrombosis post coil introduction in a rat aneurysm model: correlation of MRI findings with histopathology

IntroductionMRI plays a significant role in the post embolization follow-up of patients who have undergone coil embolization of cerebral aneurysms. We have utilized a rat aneurysm model to study the...

Safety and Efficacy of Endovascular Treatment of Basilar Tip Aneurysms by Coiling With and Without Stent Assistance

Endovascular therapy is now the preferred treatment option for basilar tip aneurysms (BTAs). To compare the safety and efficacy of common endovascular techniques in the treatment of BTAs. A retrospective review was conducted of 235 patients with BTAs treated with endovascular means in our institution between 2004 and 2011. Categorization was based on the presence and type of stent assistance (none, single, and Y stenting). The rates of perioperative complications, recanalization, rehemorrhage, and retreatment were analyzed. A total of 147 patients were treated with coil embolization and 88 patients with stent-assisted coiling (72 single stents, 16 Y stents). Thromboembolic complications occurred in 6.8% of patients in both groups. There was no associated mortality. Angiographic follow-up (mean, 23.5 months) was available in 172 patients (77.1%). Stented patients had significantly lower recanalization (17.2% vs 38.9%; P=.003) and retreatment (7.8% vs 27.8%; P=.002) rates compared with nonstented patients. Four rehemorrhages (2.7%) occurred in the coiled group, whereas none were noted in the stented group (P=.3). In paired comparisons, lower recanalization (8.3% vs 19.2%; P=.21) and retreatment (0% vs 9.6%; P=.19) rates were seen in the Y-stent group compared with the single-stent group. Thromboembolic complications occurred in 6.9% and 6.2% of patients in the single-stent and Y-stent groups, respectively (P=.91). In multivariate analysis, larger aneurysms, nonstented aneurysms, incomplete initial occlusion, and subarachnoid hemorrhage were predictors of aneurysm recanalization. Stent-assisted coiling has significantly lower recurrence, retreatment, and rehemorrhage rates than coiling alone for the treatment of BTAs. Y stenting has the highest efficacy with low complication rates.

Feasibility Study of a High Voltage In-Service-Tests on the Superconducting Magnet System of Wendelstein 7-X

During the energizing and de-energizing process of the Wendelstein 7-X magnet system, the forces induced in the superconducting coils could lead to stresses in the insulation of the coils, the interconnecting bus system, the current leads and the mechanical support structure. Such stress could cause a ground fault that would not be detected during normal operation. In normal condition the voltage across a coil group is halved by a middle point grounding system. If a ground fault is present during a fast discharge, the coil group could be stressed with the full voltage of up to 4 kV which could endanger the high voltage integrity of the whole superconducting magnet system. To prevent such undesirable occasions, the insulation of the superconducting magnet system shall be monitored by a high voltage In-Service-Test. That means that a test voltage shall be applied during the operation of the magnets. Therefore, it is planned to temporarily lift the middle point of the grounding system by a high voltage source of 2.5 kV and to measure the leak current. To evaluate the feasibility of such a system, a simulation model of one coil group has been created in Simplorer. Considering detailed parameters of the coil group, the model shall support the evaluation of how the high voltage influences the superconducting magnet system and shall determine the leak currents with and without certain damages in the insulation. The paper describes the Simplorer model with its different simulation scenarios and summarizes the results and findings.

Irreversible Electroporation Adjacent to the Rectum: Evaluation of Pathological Effects in a Pig Model

To evaluate the effects of irreversible electroporation (IRE) on the rectum wall after IRE applied adjacent to the rectum. CT-guided IRE adjacent to the rectum wall was performed in 11 pigs; a total of 44 lesions were created. In five pigs, ablations were performed without a water-filled endorectal coil (group A); in six pigs, ablation was performed with the coil to avoid displacement of the rectum wall (group B). The pigs were killed after 7-15days and the rectums were harvested for pathological evaluation. There was no evidence of perforation on gross postmortem examination. Perirectal muscle lesions were observed in 18 of 20 ablations in group A and in 21 of 24 ablations in group B. Inflammation and fibrosis of the muscularis propria was observed in ten of 18 lesions in group A and in ten of 21 lesions in group B. In group A, findings were limited to the external layer of the muscularis propria except for one lesion; in group B, findings were transmural in all cases. Transmural necrosis with marked suppurative mucosal inflammation was observed in seven of 21 lesions in group B and in no lesion in group A. IRE-ablation adjacent to the rectum may be uneventful if the rectum wall is mobile and able to contract. IRE-ablation of the rectum may be harmful if the rectum wall is fixed adjacent to the IRE-probe.

Placement of Marker Coils at Biopsy: Usefulness in the Localization of Poorly Visualized Renal Neoplasms for Subsequent CT-guided Radiofrequency Ablation

To determine whether placement of marking coils at biopsy of small renal neoplasms to facilitate localization at subsequent radiofrequency (RF) ablation is safe and can reduce fluoroscopy time during the ablative procedure. This retrospective study was approved by the hospital institutional review board and was compliant with HIPAA. The requirement to obtain informed consent was waived. A search of the renal RF ablation database (235 patients) identified 23 consecutive patients who had a marking coil placed at biopsy of a renal neoplasm (coil group) and 23 patients who did not have a marking coil placed at biopsy (control group). The patients were matched for tumor characteristics, including size, parenchymal position, location in the kidney, and laterality. All patients underwent subsequent RF ablation. The authors compared computed tomographic (CT) fluoroscopy times and technical success rates between the two groups. Statistical analyses were performed by using a single-tailed paired t test for comparison of CT fluoroscopy times, a two-tailed paired t test for comparison of age and tumor size, and a single-tailed McNemar test for comparison of the technical success rate of ablation. The mean CT fluoroscopy time for the RF ablation procedure was 28 seconds ± 11.7 (standard deviation) for the coil group and 66 seconds ± 85.8 for the control group (P = .025). There was no significant difference in the technical success rates of renal RF ablation. For small renal neoplasms that are poorly visualized at unenhanced CT, placement of a metallic marking coil at biopsy facilitates tumor localization, thus reducing CT fluoroscopy time and radiation dose for subsequent RF ablation procedures.

Abstract 2456: Quantitative Analysis Of Hemorrhage Volume For Predicting Cerebral Vasospasm After Subarachnoid Hemorrhage Between Surgical Clipping And Coil Embolization

Objective: Subarachnoid clots are important in development of delayed vasospasm after subarachnoid hemorrhage (SAH). The purpose of this study was to define the association between the subarachnoid clot volume and the incidence of symptomatic vasospasm (SV) after surgical clipping and embolization with Guglielmi detachable coils (GDCs) for aneurysmal SAH. Methods: The subjects were 155 patients with aneurysmal SAHs that were detected with a CT scan at admission and were treated by surgical clipping (Clip group, n=112) or GDC embolization (Coil group, n=43) within 72 hours of ictus between January 22, 2002 and November 22, 2009. Software-based volumetric quantification of the subarachnoid clot was performed using the voxel count method (AZE Virtual Place Fujin Raijin, AZE Ltd.). Subarachnoid clot was defined as cisternal high density areas with a Hounsfield number from 43 to 90 in the CT scan. Results: SV occurred in 24.1% and 16.3% of the patients in the Clip group (age, 63.5±12.8; male, 33.9%) and the Coil group (age, 63.0±12.6; male, 18.6%), respectively. The area under the ROC curve for subarachnoid clots for SV patients was 0.588 (95% confidence interval: 0.472-0.704; Clip group) and 0.849 (95% confidence interval: 0.714-0.985; Coil group). Using subarachnoid clot volumes of 19.6 ml (Clip group) and 32.1 ml (Coil group) as the cut-off values, the sensitivity and specificity were 89 and 39% (Clip group) and 100 and 61% (Coil group), respectively. A χ 2 test also identified that subarachnoid clots (>19.0 ml) were associated with the development of SV compared to lower blood volumes in the Clip group (≤19.0 ml, p=0.017) and that subarachnoid clots (>32.0 ml) were associated with development of SV compared to lower blood volumes in the Coil group (≤32.0 ml, p=0.03). The hemorrhage volumes of the patients with SV in the Clip group were lower than those in the Coil group at admission (37.7±21.5 vs. 58.5±23.1 ml, p=0.034), on the day after the operation (16.5±14.6 vs. 38.3±17.4 ml, p=0.002), and on Day 3-10 after SAH (5.5±4.1 vs. 11.4±9.3 ml, p=0.017). The hemorrhage volume at admission did not differ significantly between the groups (Clip group: 32.5±22.9 ml, Coil group: 32.8±22.4 ml). Conclusions: A threshold of cisternal hemorrhage volume (>19.0 ml in the Clip group and >32.0 ml in the Coil group) may exist above which patients are very likely to develop SV. Aneurysm surgery itself may be harmful to the brain (brain retraction, use of a temporary clip, and mechanical manipulation of cerebral arteries) and can lead to the onset of cerebral vasospasm.

Cognitive functions before and 1 year after surgical and endovascular treatment in patients with unruptured intracranial aneurysms

Background and purpose. This prospective study investigated whether surgery or endovascular treatment for unruptured intracranial aneurysms (UIAs) affects cognitive functions. Methods. Four neuropsychological variables from an Auditory Verbal Learning Test (overall capacity of verbal memory and delayed recall) and a Trail Making Test (psychomotor speed and cognitive flexibility) were investigated before and 1 year after treatment for UIAs in 65 patients < 61 years of age. This cohort consists of 15 men and 50 women aged 15–60 (mean age 44.9) years. Results. Group-rate analysis showed a non-significant increase in post-treatment scores in the four neuropsychological variables. In addition, no significant differences were found between the surgical clipping (SC) and endovascular coiling (EC) group. Event-rate analysis demonstrated that two patients from the EC and one from the SC group developed cognitive impairment after treatment. Conclusions. Surgical and endovascular repair for UIAs do not impair cognition in patients without postoperative restrictions in lifestyle.

Megahertz-range longitudinal guided wave excitation by a flexible magnetostrictive sensor for steel strand inspection

A new type of sensing coil for magnetostrictive sensor (MsS) is presented in this paper. The flexible printed meander coil (FPMC) can offer micron level dimensional accuracy for the structure parameters which link to the central frequency of the MsS. Thus, the actual central frequency of the FPMC-based MsS can precisely meet the expected value. The number of coil groups in the FPMC is optimised to maximise the excited and received energy of the megahertz-range longitudinal guided waves in the strand and its central rod. Meanwhile, the FPMC can be easily wrapped onto the twisted strand surface and also can be installed onto the central rod of the strand after being wrapped into multiple layers. With the proposed megahertz-range FPMC-based MsS, the rod/strand inspection system is potential to be applied for practical inspections, having higher axial inspection resolution and sensitivity to small defects.

Abstract 17919: Defibrillation Thresholds in Single Versus Dual Coil ICD Lead Systems: Is There Any Difference?

Background: Single coil implantable cardioverter defibrillator (ICD) lead systems are less often utilized even though no significant difference in defibrillation threshold (DFT) has been demonstrated in comparison to dual coil ICDs. The superior vena cava (SVC) coil is associated with an active fibrotic reaction within the SVC, which can increase complication risk during extraction. We compared DFTs between single vs. dual coil ICD leads at initial implantation. Methods: Two hundred and fifty three consecutive patients who underwent new ICD implantation from 9/2008 to 9/2010 at our institution were retrospectively analyzed. Mean follow-up was 14.6±7.3 months. Results: Single coil was used more frequently vs. dual coil (172 vs. 81 pts). Age was lower in single coil group (63.0 vs. 72.1, p&lt;0.001). There was no significant difference (single vs. dual coil, p&gt;0.05) in sex, LV EF (28.9 vs. 26.6%), body mass index, ischemic cardiomyopathy, primary prophylaxis indication, procedural complications, lead extraction during follow up, and mortality. DFT testing was performed in 92% and 86% of patients in each group. There was no significant difference in DFTs (16.6±2.8 vs. 17.3±3.2J, p=0.13), DFT safety margin (18.9±3.1 vs. 18.9±3.8J, p=0.96) and successful shocks during follow up between the two groups. The single coil group with ischemic cardiomyopathy had lower DFT (16.1±2.5 vs. 17.9±3.4J, p=0.002), but single coil group with non-ischemic cardiomyopathy had higher DFT (17.7±3.1 vs. 15.9±2.3J, p= 0.03). Right-sided implants in single coil group had lower DFTs (16.4±4 vs. 18.3±2.4J, p=0.008). Two BMI groups (BMI &lt;30 [25±2.5] vs. BMI ≥30 [35.5±4.2]) were analyzed. In BMI &lt;30 group, DFT was lower in single coil group (16.6±3.0J vs. 18.3±3.5J, p=0.008). In BMI ≥30 group, there was no significant difference in DFT between two groups (16.7±2.6 vs. 16.1±2.5, p=0.30). Conclusion: Single coil ICD leads offer adequate safety margins in patients with ischemic and non-ischemic cardiomyopathy irrespective of sex, LV function, implant site, and BMI. They should offer a better safety profile during lead extractions.

The Barrow Ruptured Aneurysm Trial

The purpose of this ongoing study is to compare the safety and efficacy of microsurgical clipping and endovascular coil embolization for the treatment of acutely ruptured cerebral aneurysms and to determine if one treatment is superior to the other by examining clinical and angiographic outcomes. The authors examined the null hypothesis that no difference exists between the 2 treatment modalities in the setting of subarachnoid hemorrhage (SAH). The current report is limited to the clinical results at 1 year after treatment. The authors screened 725 patients with SAH, resulting in 500 eligible patients who were enrolled prospectively in the study after giving their informed consent. Patients were assigned in an alternating fashion to surgical aneurysm clipping or endovascular coil therapy. Intake evaluations and outcome measurements were collected by nurse practitioners independent of the treating surgeons. Ultimately, 238 patients were assigned to aneurysm clipping and 233 to coil embolization. The 2 treatment groups were well matched. There were no anatomical exclusions. Crossing over was allowed, but primary outcome analysis was based on the initial treatment modality assignment. Posttreatment care was standardized for both groups. Patient outcomes at 1 year were independently assessed using the modified Rankin Scale (mRS). A poor outcome was defined as an mRS score > 2 at 1 year. The primary outcome was based on the assigned group; that is, by intent to treat. One year after treatment, 403 patients were available for evaluation. Of these, 358 patients had actually undergone treatment. The remainder either died before treatment or had no identifiable source of SAH. A poor outcome (mRS score > 2) was observed in 33.7% of the patients assigned to aneurysm clipping and in 23.2% of the patients assigned to coil embolization (OR 1.68, 95% CI 1.08-2.61; p = 0.02). Of treated patients assigned to the coil group, 124 (62.3%) of the 199 who were eligible for any treatment actually received endovascular coil embolization. Patients who crossed over from coil to clip treatment fared worse than patients assigned to coil embolization, but no worse than patients assigned to clip occlusion. No patient treated by coil embolization suffered a recurrent hemorrhage. One year after treatment, a policy of intent to treat favoring coil embolization resulted in fewer poor outcomes than clip occlusion. Although most aneurysms assigned to the coil treatment group were treated by coil embolization, a substantial number crossed over to surgical clipping. Although a policy of intent to treat favoring coil embolization resulted in fewer poor outcomes at 1 year, it remains important that high-quality surgical clipping be available as an alternative treatment modality.

Matrix2Coils in Embolization of Intracranial Aneurysms: 1-Year Outcome and Comparison with Bare Platinum Coil Group in a Single Institution

The endosaccular occlusion by using BPC has been useful in the treatment of intracranial aneurysms, but its limited durability remains a deep-seated drawback. The Matrix² coil, one of the bioactive-coated coils, had been developed to improve this limited durability. To evaluate durability of Matrix² coils after embolization of intracranial aneurysms, we retrospectively compared 1-year outcomes with that of BPC groups. A group of 121 aneurysms in 114 patients were embolized by using Matrix² coils between April 2006 and September 2008. The BPC group consisted of 151 aneurysms in 137 patients embolized by using BPCs alone between October 2007 and October 2008. The initial outcomes including packing densities, occlusion grades, and periprocedural complications, and the 1-year outcomes on MR angiography were retrospectively compared between the 2 groups. The Matrix² coil group and BPC group with similar baseline demographic characteristics revealed comparable initial outcomes. The rates of overall recurrence, major recanalization, and retreatment were 17.4%, 14.0%, and 10.7% versus 7.3%, 5.3%, and 4.6%, respectively (P = .066). However, the rates of subgroups with aneurysm volumes between 50 and 200 mm³ were 23.7%, 13.1%, and 10.5% versus 2.2%, 0%, and 0% (P = .022), respectively. The rates of subgroups with packing attenuation <30% were 38.3%, 31.9%, and 23.4% versus 13.3%, 11.7%, and 10% (P = .025), respectively. There were no differences in packing attenuation (P = .152), initial occlusion grade (P = .098), and 1-year outcomes (P = .209) according to the length of Matrix² coils used. Overall, initial and 1-year outcomes of the Matrix² coil group were comparable to those of the BPC group. However, in certain subgroups of aneurysm volume and packing attenuation, the 1-year durability of Matrix² coils was inferior to that of the BPC group.

Coiled Versus Straight Peritoneal Dialysis Catheters: A Randomized Controlled Trial and Meta-analysis

Variations in peritoneal dialysis catheter design include differences in numbers of cuffs, shapes of subcutaneous paths (swan neck vs Tenckhoff), and shapes of intra-abdominal segments (straight vs coiled). The relative benefits of these designs have not been studied adequately. The objective of this study is to compare the clinical outcomes of coiled- versus straight-end swan neck peritoneal dialysis catheters. Prospective randomized controlled trial (RCT); results were meta-analyzed with other RCTs of coiled versus straight catheters. 80 consecutive continuous ambulatory peritoneal dialysis patients were enrolled in the RCT. The meta-analysis considers data for 242 patients with coiled and 251 patients with straight catheters. Patients were randomly assigned to a coiled-end swan neck catheter (n = 40) or a straight-end swan neck catheter (n = 40) group. Catheter tip migration with dysfunction (primary outcome) and catheter failure, catheter-related infection, technique failure, and all-cause mortality (secondary outcomes). The primary outcome occurred in 18 patients in the coiled group and 9 in the straight group. This difference was not statistically significant (HR, 1.96; 95% CI, 0.88-4.37; P = 0.09). Although rates of early (<8 weeks) catheter tip migration were similar between the 2 groups, we detected a significant association of the coiled design with increased risk of late (>8 weeks) catheter tip migration (HR, 6.43; 95% CI, 1.45-28.6; P = 0.005). The increased risk of overall catheter failure in the coiled group was not statistically significant (P = 0.06). In the meta-analysis, coiled catheters were associated significantly with increased risk of catheter tip migration (based on 4 trials: RR, 2.08; 95% CI, 1.30-3.33; P = 0.002). Single-center open-label experimental study powered to detect differences in only the most common complication of catheter tip migration with dysfunction. Our RCT examines only swan neck catheters, whereas the meta-analysis considers both swan neck and Tenckhoff designs. Although we were unable to show statistically significant differences in the primary outcome in our RCT, pooled meta-analysis results suggest that coiled catheters may be more prone to migration and resultant dysfunction.

Bare Platinum vs Matrix Detachable Coils for the Endovascular Treatment of Intracranial Aneurysms: A Multivariate Logistic Regression Analysis and Review of the Literature

Despite increasing acceptance of endovascular coiling for treating intracranial aneurysms, incomplete occlusion remains a limitation. Attempts to reduce recanalization have prompted creation of polyglycolic/polylactic acid-coated (Matrix) coils shown to improve neointima formation; however, previous publications demonstrate conflicting results regarding their efficacy. Few studies account for factors influencing recurrence, and only 4 studies include bare platinum (BP) coil control groups. To compare initial and short- and mid-term occlusion as well as retreatment rates using Matrix compared with BP coils. Retrospective review of patients undergoing coiling of cerebral aneurysms from 2001 to 2005 was performed. Analysis included a multivariate logistic regression model designed to detect a 35% absolute difference in initial occlusion between coil treatment groups with 80% power. Complete initial occlusion was achieved in 64% of BP (n = 45) and 63% of Matrix (n = 56) cases (P = 1.0). Follow-up occlusion rates in the short term and mid term were 52% and 60%, respectively, for BP cases and 42% and 67%, respectively, for Matrix cases (P = .24 and P = .38, respectively). After adjusting for size, morphology, volumetric packing density, location, rupture, and balloon remodeling, no difference in initial and subsequent occlusion or retreatment rates for BP coils versus Matrix coils was appreciated. After controlling for factors influencing recanalization, this investigation failed to show a significant difference between coil groups.

Bioactive Coils Cause Headache and Fever After Endovascular Treatment of Intracranial Aneurysms

Based on our encounters with patients who have been treated for unruptured intracranial aneurysms by endovascular coil embolization using bioactive coils, we observed that such patients often present with headaches and fever. The purpose of this study was to evaluate the incidence of headache and fever after coil embolization using bioactive coils. A database of 92 intracranial unruptured aneurysm patients (88 patients who did not have chronic headaches or migraines before treatment) on whom coil embolization had been performed between July 2007 and October 2010 was retrospectively assessed. Forty-five aneurysms (43 patients) were treated using bioactive coils and the other aneurysms were treated using bare coils. We analyzed the incidence and duration of headache, temperature, C-reactive protein, and white blood cell count before and after coil embolization and compared the 2 groups. Forty-one patients (46.6%) reported onset of headaches just after treatment. Headache incidences were significantly greater in the patients treated with bioactive coils (bioactive coil group: 62.8% [27/43] vs bare coil group: 31.1% [14/45], P = .003), and the duration of headaches was significantly longer in the bioactive coil group (bioactive coil group: 3.44 ± 1.22 days vs bare coil group: 2.40 ± 1.17 days, P = .027). Seventy-one patients (80.7%) had incidences of fever (over 37°C) after treatment (bioactive coil group: 83.7% [36/43] vs bare coil group: 77.8% [35/45], P = .663). The duration of fever was significantly longer in the bioactive coil group (bioactive coil group: 2.9 ± 1.4 days vs bare coil group: 1.9 ± 1.1 days, P = .0017), and temperatures at 1, 2, or 3 days after treatment were significantly higher in the bioactive coil group (respective temperatures at 1, 2, 3 days after treatment: bioactive coil group: 37.42 ± 0.49, 37.19 ± 0.45, 37.00 ± 0.49 vs bare coil group: 37.14 ± 0.38, 36.96 ± 0.41, 36.63 ± 0.51, P = .009, P = .0246, P = .0032). There were no significant differences in C-reactive protein level and white blood cell count 1 and 3 days after treatment between 2 groups. Bioactive coils induce headache and fever after coil embolization for intracranial aneurysms due to the inflammatory effects of polyglycolic acid used to accelerate aneurysm fibrosis and neointimal formation.

Practice variability and outcomes of coil embolization of aortopulmonary collaterals before fontan completion: A report from the Pediatric Heart Network Fontan Cross-Sectional Study

The practice of coiling aortopulmonary collaterals (APCs) before Fontan completion is controversial, and published data are limited. We sought to compare outcomes in subjects with and without pre-Fontan coil embolization of APCs using the Pediatric Heart Network Fontan Cross-Sectional Study database which enrolled survivors of prior Fontan palliation. We compared hospital length of stay after Fontan in 80 subjects who underwent APC coiling with 459 subjects who did not. Secondary outcomes included post-Fontan complications and assessment of health status and ventricular performance at cross-sectional evaluation (mean 8.6 ± 3.4 years after Fontan). Centers varied markedly in frequency of pre-Fontan APC coiling (range 0%-30% of subjects, P < .001). The coil group was older at Fontan (P = .004) and more likely to have single right ventricular morphology (P = .054) and pre-Fontan atrioventricular valve regurgitation (P = .03). The coil group underwent Fontan surgery more recently (P < .001), was more likely to have a prior superior cavopulmonary anastomosis (P < .001), and more likely to undergo extracardiac Fontan connection (P < .001) and surgical fenestration (P < .001). In multivariable analyses, APC coiling was not associated with length of stay (hazard ratio for remaining in-hospital 0.91, 95% CI 0.70-1.18, P = .48) or postoperative complications, except more post-Fontan catheter interventions (hazard ratio 1.74, 95% CI 1.04-2.91, P = .03), primarily additional APC coils. The groups had similar outcomes at cross-sectional evaluation. Management of APCs before Fontan shows marked practice variation. We did not find an association between pre-Fontan coiling of APCs and shorter postoperative hospital stay or with better late outcomes. Prospective studies of this practice are needed.

O-024 UHC Data Indicates Higher Mortality Rate in Aneurysms Embolized with Bare Platinum Coils Compared with Polymer Enhanced Coils

IntroductionRecently, ICD-9 procedure coding for hospitals has changed to reflect aneurysm embolization with either bare metal coils or polymer-enhanced coils, and 2010 was the first year that an entire calendar...