HydroCoil Endovascular Aneurysm Occlusion and Packing Study (HELPS Trial): Procedural Safety and Operator-Assessed Efficacy Results
| Autor: | Philip White, T Goddard, Anil Gholkar, R. J. Sellar, Steff Lewis, Hans Nahser |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2008 |
| Předmět: |
Adult
Male International Subarachnoid Aneurysm Trial medicine.medical_specialty Subarachnoid hemorrhage Adolescent medicine.medical_treatment Comorbidity Risk Assessment law.invention Expedited Publication Aneurysm Randomized controlled trial law Risk Factors Occlusion medicine Secondary Prevention Humans Radiology Nuclear Medicine and imaging Embolization Heart Aneurysm Survival rate Aged Aged 80 and over business.industry Mortality rate Incidence Middle Aged medicine.disease Embolization Therapeutic Survival Analysis United Kingdom Surgery Radiography Survival Rate Treatment Outcome Female Neurology (clinical) business Hydrocephalus |
| Zdroj: | AJNR Am J Neuroradiol |
| Popis: | BACKGROUND AND PURPOSE: Coated coils have been in clinical use for several years without robust evidence to determine their safety/efficacy. The HydroCoil Endovascular Aneurysm Occlusion and Packing Study (HELPS) addresses this deficiency for the HydroCoil embolic system. This article reports periprocedural safety/operator-assessed angiographic results from HELPS. MATERIALS AND METHODS: Patients were randomized to the hydrogel coil or control arms by using concealed allocation with minimization matching groups. Any bare platinum coils were allowed in the control arm, and assist devices could be used as clinically required. Both recently ruptured and not recently ruptured/unruptured aneurysms were included. Analysis was on an intention-to-treat basis. RESULTS: Four hundred ninety-nine patients were recruited. Coiling was successful in 98.6%. Mean aneurysm size was 6.5 mm (26% were ≥10 mm), 53% were recently ruptured aneurysms, and an assist device was used in 46%. Seventy procedural adverse events were reported in hydrogel coils and 86 in control arms. The 3-month mortality rate was 3.6% in hydrogel coils and 2.0% in control arms; the difference was not significant (P = .6). There was a lower 2-month mortality rate in the HELPS subarachnoid hemorrhage cohort (4.1%) than would be anticipated from the International Subarachnoid Aneurysm Trial (7%). There was a trend toward increased adverse events when assist devices were used, which was substantial for stents deployed in recently ruptured aneurysms. Ninety-six percent of patients discharged were World Federation of Neurosurgeons grade 0–2 at discharge. No difference was found between arms in the operator assessment of angiographic occlusions (P = .3). CONCLUSION: These HELPS results reinforce coiling as an effective treatment for aneurysms, with an excellent technical success rate. Hydrogel coils can be used in a wide spectrum of aneurysms with a risk profile equivalent to that of bare platinum. |
| Databáze: | OpenAIRE |
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