Endovascular treatment of 404 intracranial aneurysms treated with nexus detachable coils: short-term and mid-term results from a prospective, consecutive, European multicenter study
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Aneurysm recanalization remains a limitation of endovascular treatment. A new type of bioactive coil, the polyglycolic/polylactic acid-covered platinum microfilaments Nexus coil (ev3/Covidien, Irvine, CA, USA), has been proposed. The objective is to evaluate the safety and short-term and mid-term efficacy of Nexus coils in the endovascular treatment of intracranial aneurysms.
The ENDECOR (European Nexus Detachable Coil Registry) is the first prospective, consecutive, multicenter non-randomized registry. After providing informed consent, 390 patients (238 women and 152 men; mean age, 51.6 years) with 404 ruptured or unruptured aneurysms were enrolled at 34 centers. Treatment was performed with at least 75 % of coil length as Nexus coils. Clinical and technical complications were systematically reported. An independent core laboratory evaluated angiographic results by using the Raymond Grading Scale.
Complete occlusion was seen in 181 aneurysms (48 %); neck remnant in 86 aneurysms (22 %) and aneurysm remnant in 111 aneurysms (30 %). Technical and clinical complications related to the procedure occurred in 33 patients (8.5 %). At discharge, overall mortality and permanent-morbidity were 4.1 % (16/390) and 5.6 % (14/251), respectively. Angiographic mean follow-up of 13.3 months was obtained in 233 of 390 patients (64.4 %) harboring 247 aneurysms. Recanalization was observed in 44 aneurysms (17.7 %), and progressive thrombosis was observed in 53 aneurysms (21.6 %).
Endovascular treatment of intracranial aneurysms with Nexus coils was associated with low morbidity and mortality rates. Efficacy of Nexus coils was comparable to published series of intracranial aneurysms treated with bare platinum coils, but their efficacy to prevent aneurysm recanalization was not demonstrated.
KeywordsIntracranial aneurysms Coiling Endovascular treatment Recanalization
We are grateful to all the investigators and coordinators for the support and hard work in enrolling patients, completing data collection forms, and participating in the study.
Conflicts of interest
- 4.Matrix and Platinum Science (MAPS) (2011) Abstract. Eighth Annual Meeting of the Society of Neurointerventional Surgery (SNIS); Colorado Springs, CO; July 25–28Google Scholar
- 5.Molyneux AJ, Clarke A, Sneade M, Mehta Z, Coley S, Roy D, Kallmes DF, Fox AJ (2012) Cerecyte coil trial: angiographic outcomes of a prospective randomized trial comparing endovascular coiling of cerebral aneurysms with either cerecyte or bare platinum coils. Stroke 43:2544–2550PubMedCrossRefGoogle Scholar
- 6.Molyneux AJ, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R, International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1262–1274CrossRefGoogle Scholar
- 17.White PM, Lewis SC, Gholkar A, Sellar RJ, Nahser H, Cognard C, Forrester L, Wardlaw JM, HELPS trial collaborators (2011) Hydrogel-coated coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms (HELPS): a randomised controlled trial. Lancet 377:1655–1662PubMedCrossRefGoogle Scholar