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Clinical outcomes of first- and second-generation hydrogel coils compared with bare platinum coils: a systematic literature review

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Abstract

Endovascular coiling has revolutionized intracranial aneurysm treatment; however, recurrence continues to represent a major limitation. The hydrogel coil was developed to increase packing density and improve neck healing and therefore decrease recurrence rates. In this paper, we review treatment outcomes of first- (1HCs) and second-generation (2HCs) hydrogel coils and compare them to those of bare platinum coils (BPC). A query of multiple databases was performed. Articles with at least 10 aneurysms treated with either 1HC or 2HC were selected for analysis. Collected data included aneurysm size, rupture status, initial occlusion, initial residual neck/aneurysm, packing density, mortality, morbidity, recurrence, and retreatment rates. The primary endpoint was recurrence at final follow-up. Secondary endpoints included residual neck and dome rates as well as procedure-related complications and functional dependence at final follow-up. Studies that compared 1HC to BPC showed significant lower recurrence (24% vs. 30.8%, p = 0.02) and higher packing density (58.5% vs. 24.1%, p < 0.001) in 1HC but no significant difference in initial occlusion rate (p = 0.08). Studies that compared 2HC to BPC showed lower recurrence (6.3% vs. 14.3%, p = 0.007) and retreatment rates (3.4% vs. 7.7%, p = 0.010) as well as higher packing density (36.4% vs. 29.2%, p = 0.002) in 2HC, with similar initial occlusion rate (p = 0.86). The rate of complications was not statistically different between HC (25.5%) and BPC (22.6%, p = 0.06). Based on our review, the 1HC and 2HC achieved higher packing density and lower recurrence rates compared to BPC. The safety profile was similar between both groups.

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Data availability

Data obtained for this project is available in the supplementary online materials.

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Authors and Affiliations

  1. Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, AZ, USA

    Karl R. Abi-Aad, Rudy J. Rahme, Devi P. Patra, Evelyn L. Turcotte, Arjun Syal, Miles Hudson, Chandan Krishna & Bernard R. Bendok

  2. Department of Neurosurgery, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85213, USA

    Karl R. Abi-Aad, Rudy J. Rahme, Devi P. Patra, Evelyn L. Turcotte, Arjun Syal, Miles Hudson, Chandan Krishna & Bernard R. Bendok

  3. Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA

    Kent R. Richter, Sarah A. Merrill & Jose O. Garcia

  4. Mayo Clinic Kern Center for the Science of Health Care Delivery, Phoenix, AZ, USA

    Matthew R. Neville

  5. Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA

    Rabih G. Tawk

  6. Department of Radiology, Mayo Clinic, Phoenix, AZ, USA

    Brian W. Chong

Authors
  1. Karl R. Abi-Aad
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  2. Rudy J. Rahme
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  14. Bernard R. Bendok
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Contributions

Concept and oversight: Bernard R. Bendok. Data acquisition: Karl R. Abi-Aad, Kent R. Richter, Arjun Syal. Manuscript preparation and editing: Rudy J. Rahme, Devi, Evelyn L. Turcotte, Sarah A. Merrill, Matthew R. Neville, Miles Hudson, Jose O. Garcia, Rabih G. Tawk, Brian W. Chong, Chandan Krishna.

Corresponding author

Correspondence to Bernard R. Bendok.

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Supplementary Information

Supplementary Figure 1

Random effects forest plot of comparison: first-generation hydrogel coil versus bare platinum coil. Outcome: initial rate of occlusion. (GIF 15 kb)

Supplementary Figure 2

Random effects forest plot of comparison: first-generation hydrogel coil versus bare platinum coil. Outcome: residual neck. (GIF 15 kb)

Supplementary Figure 3

Random effects forest plot of comparison: first-generation hydrogel coil versus bare platinum coil. Outcome: residual aneurysm. (GIF 15 kb)

Supplementary Figure 4

Random effects forest plot of comparison: first-generation hydrogel coil versus bare platinum coil. Outcome: packing density. (GIF 14 kb)

Supplementary Figure 5

Random effects forest plot of comparison: first-generation hydrogel coil versus bare platinum coil. Outcome: retreatment. (GIF 15 kb)

Supplementary Figure 6

Random effects forest plot of comparison: second-generation hydrogel coil versus bare platinum coil. Outcome: initial occlusion rate. (GIF 14 kb)

Supplementary Figure 7

Random effects forest plot of comparison: second-generation hydrogel coil versus bare platinum coil. Outcome: initial residual neck. (GIF 12 kb)

Supplementary Figure 8

Random effects forest plot of comparison: second-generation hydrogel coil versus bare platinum coil. Outcome: initial residual aneurysm. (PNG 17 kb)

Supplementary Figure 9

Random effects forest plot of comparison: second-generation hydrogel coil versus bare platinum coil. Outcome: packing density. (GIF 14 kb)

Supplementary Figure 10

Random effects forest plot of comparison: second-generation hydrogel coil versus bare platinum coil. Outcome: retreatment. (GIF 13 kb)

Supplementary Figure 11

Random effects forest plot of comparison: hydrogel coil versus bare platinum coil. Outcome: procedure-related complications. (GIF 19 kb)

Supplementary Figure 12

Random effects forest plot of comparison: hydrogel coil versus bare platinum coil. Outcome: functional dependence. (GIF 14 kb)

Supplementary Figure 13

Random effects forest plot of comparison: hydrogel coil versus bare platinum coil. Outcome: delayed hydrocephalus. (GIF 14 kb)

Supplementary Figure 14

Random effects forest plot of comparison: hydrogel coil versus bare platinum coil. Outcome: mortality. (GIF 18 kb)

Supplementary Figure 15

Random effects forest plot of comparison: hydrogel coil versus bare platinum coil. Outcome: thromboembolic events. (GIF 19 kb)

Supplementary Figure 16

Random effects forest plot of comparison: hydrogel coil versus bare platinum coil. Outcome: coil herniation or technical difficulties relate to coil. (GIF 18 kb)

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Abi-Aad, K.R., Rahme, R.J., Patra, D.P. et al. Clinical outcomes of first- and second-generation hydrogel coils compared with bare platinum coils: a systematic literature review. Neurosurg Rev 45, 1873–1882 (2022). https://doi.org/10.1007/s10143-021-01632-z

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  • DOI: https://doi.org/10.1007/s10143-021-01632-z

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