The Clinic Study Of Endovascular Aneurysm Occlusion With Hydrocoil

Backgroud Endovascular coil embolization using bare platimum coil has become an accepted therapeutic option for the treatment of intracranial aneurysms. The most important limitation of coil embolization is the possibility of aneurysm recanalization,which results in aneurysm recurrence.Platinum coils are biologically inert and produce a limited and delayed inflammatory response.To overcome this limitation,various modified coils have been developed and are commercially available,including some polyglycolic acid copolymer(PGLA)-coated colis(Matrix), and a hydrogel-coated coil(Hydrocoil).Hydrocoil is an embolic agent that improves packing attenuation might reduce the rate of aneurysm recurrence.The Hydrocoil is construsted as a hybrid hydroger-platimum coil device.The initial diameter of these devices is 0.009 inch,and the expanded diameter is 0.027 inch.In blood the hydrogel swells to its maximum diameter(3 times the original coil diameter) in approximately 20 minutes.Hydrocoil received the US Food and Drug Adminidtration on July 29, 2002.Our hospital has initially ues Hydrocoil to treat aneurysms from 2005.Objective To study the clinical effectiveness and safety of endovascular aneurysm occlusion with hydrocoil,compare complete obliteration rate,volume embolization ratio,recanalization,rebleed,complication and Modified Rankin scale between hydrocoil and bare platinum coil.Methods A retrospective analysis was conducted of a total of 95 patients with Bare platinum coils and Hydrocoil who had full clinical data in our hospital from 2005 to 2007.Amone them,there were 11 patients lost,11.58%.The inclusion criteria were as follows:1) ruptured or unruptured intracranial aneurysm,2) Age＜80, maximal aneurysmal diameter≥2mm,3) The Bare platinum include Microplex, Orbit,NXT,GDC 10 or GDC 18,The Hydrocoil include Hydrocoil10,Hydrocoil14, Hydrocoil18(Micovention).The exclusion criteria included:1) complex-shaped(or severely multilobulated) aneurysms,fusiform,infectious,traumatic or dissecting aneurysms;2) Multiple Aneurysms;3) Patients undergoing arterial occlusion with coils.4).Giant aneurysms,maximal aneurysmal diameter＞25mm; 5).flaiembolization with other coated coils;6).stent-assisted coil embolization, remoding or other assisitive technology;7) recanalizion aneurysms.In all patients with full clinical date,84 patients have followed up over 6 months.The patients have divide into Hydrocoils group of 41 patients and Bare platinum coil of 43 patients to compare complete obliteration rate,volume embolization ratio,recanalization, rebleed,complication and Modified Rankin scale between hydrocoil and bare platinum coil.Statistical analysis was performed using Statistical Package for Social Sciences(SPSS 11.5).Datum for Hydrocoil,Bare platinum coils were analyzed using X~2 tests,Independent-Samples T test,two-way ANOVA and Wilcoxon's rank sum test.P＜0.05 was considered significant.Results1.Aneurysm complete obliteration rate after endvosculation.Complete obliteration rate were better in Hydrocoil(87.5%) than Bare platinum Coil(74.4%),but there were no statistically significantly different(P=0.118). Complete obliteration rate of Hydrocoil group in small,medium,large aneurysm were 100%,84.4%,50%,respectively,that better than Bare platinue group in small, medium,large aneurysm were 94.1%,65.2%,33.3%,respectively.2.volume embolization ratio(VOA)Volume embolization ratio for Hydrocoil(66.72±14.28%) was significantly (t'=8.140,P=0.000) greater than Bare platinum coil(32.86±22.61%).Volume embolization ratio for Hydrocoil group in small,medium aneurysm were 83.29±21.94%,65.70±19.71%,respectively.Volume embolization ratio for Bare platinue group in small,medium aneurysm were 46.20±9.92%,29.00±0.12.10%, respectively.The tow group have statistically significantly different(F=31.082, P=0.000).Large aneurysms in Hydrocoil group is 3 case,24.98%,but in Bare platinue group is 2 case,8.67%.3.Aneurysm recanalizationAneurysm recanalization rate for Bare platinum coil(20.9%) was significantly (P=0.043) greater than Hydrocoil(9.8%) with X~2 test(X~2=4.076).Among 13 patients of Aneurysm recanalization,11 case(84.62%) of VOA lower 25%,2 case (15.38%) of VOA over 25%.5 case(38.46%) have complete obliteration after procedure,and 8 case(61.54%) have no complete obliteration.4.RebleedingOne pantient have rebleeding in the group of Hydrocoil,threre in the group of Bare platinum.The rebleed rate is 2.44%,6.98%respectively.5.ComplicationThe complication for Hydrocoil and Bare platinum coil is 19.5%,16.3% respectively.Procedural complications rate of Hydrocoil group and Bare platinum coils group were 12.19%and 4.65%respectively and the long-term complication were 7.13%,11.61%respectively.6.Survial free of disability at 6 months(Modified Rankin scale)There were no differ significantly between the two treatment groups(80.49%and 79.07%for endovascular with Hydrocoil and Bare platinum coils respectively.Conclusion1.Endovascular aneurysm occlusion with hydrocoi is effective and safity.2.Aneurysm recanalization associated with volume embolization ratio. Improvement of volume embolization ratio could reduce aneurysm recanalization rate.3.Endovascular aneurysm occlusion with hydrocoil improve complete obliteration rate and reduce recanalization rate,especially for medium and large aneruysms.4.Endovascular aneurysm occlusion with hydrocoil have better rate of Survial free of disability at 6 months,low complication(Procedural complications and long-term complication).5.Durability of aneurysm occlusion with Hydrocoil in the long-term is still unknown and necessary to study.