Endovascular treatment of intracranial aneurysms with matrix detachable coils: immediate posttreatment results from a prospective multicenter registry

Abstract

Background and purpose: Endovascular treatment of intracranial aneurysms by using detachable coils has become an accepted alternative to surgery. To reduce the rate of aneurysm recanalization after treatment, biologically active polyglycolic/polylactic acid-covered platinum coils have been proposed. A prospective and multicenter registry was conducted in France to evaluate the safety and short-term and long-term efficacy of Matrix detachable coils. This first analysis is focused on the safety and short-term efficacy.

Methods: Two hundred sixty-one patients having ruptured or unruptured aneurysms treated via endovascular approach were included in this registry. Patients with giant aneurysms or in poor clinical condition (Glasgow Coma Scale < 10) were excluded. Because of various protocol violations, clinical analysis was conducted in 236 patients having 244 aneurysms. Technical and clinical complications were systematically recorded. Angiographic analysis was performed by a core laboratory by using the Raymond Grading Scale on 224 patients having 232 aneurysms.

Results: Complete occlusion was achieved in 102 aneurysms (44.0%); neck remnant, in 58 aneurysms (25.0%); and aneurysm remnant, in 72 aneurysms (31.0%). Technical and clinical complications related to the procedure were encountered in 43 patients (18.2%). Postoperative modification of the clinical status was observed in 12 patients (5.1%). Two patients died (0.8%), 6 had a permanent deficit (2.5%), and 4 had a transient deficit (1.7%). Treatment-related mortality was 0.8% and permanent morbidity was 2.5%.

Conclusion: Endovascular treatment of intracranial aneurysms by using Matrix detachable coils is feasible and demonstrated initial angiographic results and overall morbidity and mortality rates that are within the ranges found in the literature in the use of bare platinum coils.

Fig 1.

HH scale.

Fig 2.

Glasgow Coma Scale grade.

Fig 3.

Relative ratio matrix/GDC (length of coils).

Fig 4.

Acute anatomic analysis (number of aneurysms).

Fig 5.

Treatment-related events (number of patients). Percentages are related to the total number of patients.

Fig 6.

Thromboembolic events related to aneurysm localization (percentages). Percentages are related to the total number of aneurysms for each localization. CI: carotid siphon, 6.3–18.0%; anterior communicating artery and anterior cerebral artery, 4.5–17.8%; middle cerebral artery, 12.3–37.5%; basilar artery, 3.7–37.9%.

Fig 7.

Thromboembolic events related to the percentage of PGLA. Percentages are calculated in each group of patients defined according to the relative ratio matrix/GDC (Fig 3). CI: PGLA 100%, 7.5%–18.5%; PGLA 50%–99%, 7.6%–21.4%; PGLA <50%, 3.1%–32.8%.

Fig 8.

Permanent morbidity and mortality related to the treatment.