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. 2024 May 3;7(1):42.
doi: 10.1186/s42155-024-00454-6.

ELECT: prospective, randomized trial comparing microvascular plug versus platinum-fibered microcoils for embolization of aneurysm sac side branches before endovascular aortic aneurysm repair

Manuela Konert  1   2 , Andrej Schmidt  3 , Daniela Branzan  4   5 , Tim Wittig  3   5 , Dierk Scheinert  3 , Sabine Steiner  3   5
Affiliations

ELECT: prospective, randomized trial comparing microvascular plug versus platinum-fibered microcoils for embolization of aneurysm sac side branches before endovascular aortic aneurysm repair

Manuela Konert et al. CVIR Endovasc. .

Abstract

Background: Preemptive selective embolization of aneurysm sac side branches (ASSBs) has been proposed to prevent type II endoleak after endovascular aortic aneurysm repair (EVAR). This study aimed to explore if an embolization strategy using microvascular plugs (MVP) reduces intervention time and radiation dose compared to platinum-fibered microcoils. Furthermore, the effectiveness of the devices in occluding the treated artery was assessed.

Methods: Sixty patients scheduled for EVAR underwent percutaneous preemptive embolization of ASSBs using MVPs or coils after a 1:1 randomization. Follow-up imaging was performed during aortic stentgraft implantation.

Results: Overall, 170 ASSBs were successfully occluded (83 arteries by MVPs and 87 by coils) and no acute treatment failure occurred. The mean procedure time was significantly lower in the group treated with MVPs (55 ± 4 min) compared to coil occlusion (67 ± 3 min; p = 0.018), which was paralleled by a numerically lower radiation dose (119 Gy/cm2 vs. 140 Gy/cm2; p = 0.45). No difference was found for contrast agent use (34 ml MVP group vs 35 ml coil group; p = 0.87). At follow-up, reopening of lumbar arteries was seen in nine cases (four after coil embolization; five after MVPs).

Conclusion: Both microvascular plugs and coils can be effectively used for preemptive embolization of aneurysm sac side branches before EVAR. Use of plugs offers a benefit in terms of intervention time.

Trial registration: ClinicalTrials.gov Identifier: NCT03842930 Registered 15 February 2019.

Keywords: Aortic aneurysm; Coil; EVAR; Embolization; Endoleak; Lumbar artery; Plug.

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Conflict of interest statement

M. Konert Consultant for Inari, Speaking Fees: Bayer, Abbott.

A. Schmidt Consultant for Abbott, Boston Scientific, Cook Medical, Cordis, CR Bard, ReFlow Medical, Upstream Peripheral Technologies.

D. Branzan Grants and Speaking Fees from: Artivion, Bentley Innomed GmbH, Cook Medical, Endologix, Getinge, Medtronic.

T. Wittig none.

D. Scheinert Consultant or advisory board member for Abbott, Biotronik, Boston Scientific, Cook Medical, Cordis, CR Bard, Gardia Medical, Medtronic/Covidien, TriReme Medical, Trivascular and Upstream Peripheral Technologies.

S. Steiner Consultant or advisory board member for Boston Scientific, Cook Medical, iThera Medical.

Figures

Fig. 1
Fig. 1
Patient 1 (A-C) Embolization with coils, A Angiogram of the Aorta with a pigtail catheter showing 4 patent ASSBs (L3 and L4 both sides) and the left renal artery, the IMA and the left renal artery; B Selective angiogram of the lower right ASSBs with SOS catheter and a microcatheter; C Complete arterial flow cessation after coil-embolization of the target artery with fibered coils (Cook medical, Indiana, United States); Patient 2 (D and Dd) Embolization with MVP, D Stentgraft inserted via the right groin and the pigtail-catheter to perform an angiography via left groin. MVP (Medtronic Dublin, Ireland) (white arrow) in the lumbar arteries L4 right and L4 and L3 left side, occlusion of the inferior mesenteric artery with coils, Dd Magnification of the same picture
See this image and copyright information in PMC

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