Initial clinical experience with Matrix detachable coils for the treatment of intracranial aneurysms

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Object

The Matrix detachable coil is a new bioactive, bioabsorbable coil used in the endovascular embolization of intracranial aneurysms. It has a platinum core covered with a bioactive, bioabsorbable polymer (polyglycolic acid/lactide). The authors report on their initial midterm clinical experience with the first-generation Matrix detachable coil.

Methods

One hundred twelve patients harboring 118 aneurysms were treated using Matrix coils. Forty-nine aneurysms (41.5%) were associated with acute subarachnoid hemorrhage (SAH). Twenty-four lesions (49%) were harbored by patients with Hunt and Hess Grade I, 11 (23.4%) by patients with Grade II, eight (16.3%) by those with Grade III, and six (12.2%) by those with Grade IV. Four aneurysms (3.4%) were harbored by patients who had presented with nonacute SAH. Sixty-five aneurysms (55%) were unruptured. Fifty-seven lesions (48.3%) were small with a small neck, 29 (24.6%) were small with a wide neck, 30 (25.4%) were large, and two (1.7%) were giant. All patients were followed up to obtain angiography and clinical outcome data.

Technical complications occurred in six patients: two thromboembolic complications and four aneurysm perforations. Of these six patients, the status of two deteriorated because of aneurysm perforation and another two because of thrombus formation (morbidity 3.6%). There were five deaths—one due to rerupture after embolization. Angiography follow-up studies of 87 aneurysms were obtained. Seventy aneurysms demonstrated progressive occlusion or a stable neck (80.5%), and 17 had some degree of recanalization (19.5%). The aneurysms originally diagnosed as a neck remnant showed a 15% rate of recanalization.

Conclusions

Matrix coils can be delivered into aneurysms with technical complications similar to those encountered using GDCs. Midterm anatomical outcomes to date have shown moderate improvement in the recanalization rate when compared with those realized using the GDC system. Because of the increased friction associated with the first-generation Matrix coil, the packing density in most aneurysms was less than that achieved with GDCs. Prolonged angiography follow-up evaluations are needed to document long-term efficacy.

Abbreviations used in this paper:ACoA = anterior communicating artery;; ACTIVE = Acceleration of Connective Tissue Formation in Endovascular Aneurysm Repair;; GDC = Guglielmi detachable coil;; PCoA = posterior communicating artery;; PGLA = polyglycolic; poly-l-lactic acid;; SAH = subarachnoid hemorrhage;; 3D = three-dimensional.

Article Information

Address reprint requests to: Yuichi Murayama, M.D., Division of Interventional Neuroradiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS, Room B7-146ª, Los Angeles, California 90095-1721. email: ymurayama@jikei.ac.jp or ymurayama@mednet.ucla.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Fig. 1. Images showing the 3D shape of the Matrix detachable coil (left) as well as the inner and outer design (right).

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    Fig. 2. Bar graph demonstrating the immediate postembolization angiography outcome. The complete occlusion rate was increased in the post-ACTIVE group.

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    Fig. 3. A: Angiogram obtained in a 70-year-old man, revealing an incidental aneurysm directly arising from the right PCoA (7 × 6 mm, neck 4 mm. A total of six Matrix coils was used. B: Immediate postembolization angiogram demonstrating small neck remnant. C: Twelve-month follow-up angiogram demonstrating complete obliteration of the aneurysm. There was translucent border between the coil mass and the PCoA (parent artery).

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    Fig. 4. A: Angiogram obtained in a 65-year-old woman who had presented with a ruptured right basilar artery–superior cerebellar artery aneurysm, demonstrating a 5.5 × 4–mm aneurysm (neck 4 mm). The aneurysm was embolized with three Matrix coils. B: Immediate postembolization angiogram showing a neck remnant and slight coil protrusion into the parent artery. C: Three-month postembolization angiogram demonstrating complete obliteration. D: Three-dimensional digital subtraction angiogram obtained 12 months postembolization revealing complete obliteration with a clear border between the coil mass and the parent artery.

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    Fig. 5. A: Angiogram (anteroposterior view) obtained in a 38-year-old woman who had presented with an unruptured cavernous sinus aneurysm (11 × 10 mm), demonstrating a wide (6 mm) and difficult-to-identify neck. The Matrix coil was delivered into the aneurysm without the balloon-assisted technique. B: Angiogram (lateral view) showing the wide aneurysm neck. Embolization was terminated because of uncertainty regarding coil protrusion into the parent artery. C: Three-month follow-up angiogram demonstrating an unprotected aneurysm and remodeling of the coil shape. D: Angiogram obtained after a second successful embolization using a balloon-assisted technique, showing occlusion of the aneurysm.

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    Fig. 6. Bar graph demonstrating midterm angiography outcomes by group. There was an increase in the rate of completely embolized aneurysms and a decrease in the neck remnants in the post-ACTIVE group.

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    Fig. 7. Bar graph exhibiting the midterm rates for angiographically demonstrated recanalization and thrombosis by group. There was an increase in the rate of further thrombosis and a decreased rate of recanalization in the post-ACTIVE group.

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