GREAT-a randomized controlled trial comparing HydroSoft/HydroFrame and bare platinum coils for endovascular aneurysm treatment: procedural safety and core-lab-assessedangiographic results

  • Christian A Taschner
  • René Chapot
  • Vincent Costalat
  • Paolo Machi
  • Patrick Courthéoux
  • Xavier Barreau
  • Jérôme Berge
  • Laurent Pierot
  • Kryzsztof Kadziolka
  • Betty Jean
  • Raphaël Blanc
  • Alessandra Biondi
  • Hervé Brunel
  • Sophie Gallas
  • Ansgar Berlis
  • Denis Herbreteau
  • Joachim Berkefeld
  • Horst Urbach
  • Samer El Shikh
  • Jens Fiehler
  • Hubert Desal
  • Erika Graf
  • Alain Bonafé

Abstract

INTRODUCTION: Hybrid hydrogel-platinum coils (HydroCoil) have proven effective for endovascular aneurysm treatment. To overcome technical limitations (coil stiffness, time restriction for placement), a second generation of softer hydrogel coils has been brought to clinical practice (HydroSoft, HydroFrame). We report on procedural safety and core-lab-assessed angiographic results from an open-label multicenter randomized controlled trial.

METHODS: Web-based randomization occurred in 15 medical centers in France and seven in Germany between coil embolization with second-generation hydrogel coils and treatment with any bare platinum coil. Assist devices could be used as clinically required. Primary endpoint is a composite outcome including major aneurysm recurrence and poor clinical outcome at 18 months follow-up.

RESULTS: Five hundred thirteen patients were randomized (hydrogel n = 256, bare platinum n = 257). Twenty patients were excluded for missing informed consent and nine patients for treatment related criteria. Four hundred eighty-four patients were analyzed as randomized (hydrogel n = 243, bare platinum n = 241). Two hundred eight had ruptured aneurysms (43 %). Prespecified procedural complications occurred in 58 subjects (hydrogel n = 28, bare platinum n = 30, p = 0.77). The 14-day mortality rate was 2.1 % in both arms of the study. The median calculated packing densities for aneurysms assigned to hydrogel and bare platinum were 39 and 31 % respectively (p < 0.001). No statistically significant differences were found between arms in the post procedural angiographic occlusion rate (p = 0.8).

CONCLUSION: Second-generation hydrogel coils can be used in a wide spectrum of aneurysms with a risk profile equivalent to bare platinum. Packing density was significantly higher in aneurysms treated with hydrogel coils.

TRIAL REGISTRATION: http://www.germanctr.de , DRKS00003132.

Bibliografische Daten

OriginalspracheEnglisch
ISSN0028-3940
DOIs
StatusVeröffentlicht - 08.2016
PubMed 27137926