‘Bioactive’ coils disappoint for cerebral aneurysms

By Eleanor McDermid, Senior MedWire Reporter

The angiographic outcomes of patients in the Cerecyte Coil Trial (CTC) add to evidence that "bioactive" coils are no better than bare platinum coils in patients with cerebral aneurysms.

At 5-7 months after coiling, the investigators found that 59% of 215 patients given the bioactive Cerecyte coil (Micrus Endovascular, San Jose, California, USA) and 54% of 218 given a bare platinum coil had angiographic occlusion.

The lack of extra benefit from bioactive coils is in line with the findings of the HELPS (Hydro-Coil Endovascular Aneurysm Occlusion and Packing Study) and MAPS (Matrix And Platinum Science) studies.

"This questions the rationale for their use, particularly at significantly increased financial cost," Andrew Mollyneux (John Radcliffe Hospital, Oxford, UK) and colleagues write in Stroke.

Bioactive coils are designed to promote complete aneurysm occlusion by either encouraging clotting within the aneurysm or improving packing. In CTC, successful angiographic occlusion, as determined by a central core laboratory, was defined as an aneurysm that was completely occluded, had a stable neck remnant, or had improved relative to its appearance on the post-treatment angiogram.

The core laboratory considered that 16.7% of aneurysms treated with a Cerecyte coil developed major recurrence relative to the post-treatment angiogram (≥2 mm deterioration), as did 11.9% of those treated with bare platinum coils. This difference was not significant. Retreatment was at the discretion of the treating center, and occurred for 7.7% of patients in the Cerecyte group and 3.5% of those in the bare platinum coil group.

About half of the patients had aneurysms that had recently ruptured at the time of coiling. However, there were just two rebleeds throughout the whole study period, both in the Cerecyte group.

The researchers remark that it is not yet clear if angiographic occlusion reliably indicates absence of subarachnoid hemorrhage risk. They also question whether the "quest for a perfect angiographic result" is valid, ie, whether less than complete occlusion actually increases the risk for a rebleed.

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