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Research ArticleInterventional

Bioactive versus Bare Platinum Coils in the Treatment of Intracranial Aneurysms: The MAPS (Matrix and Platinum Science) Trial

C.G. McDougall, S. Claiborne Johnston, A. Gholkar, S.L. Barnwell, J.C. Vazquez Suarez, J. Massó Romero, J.C. Chaloupka, A. Bonafe, A.K. Wakhloo, D. Tampieri, C.F. Dowd, A.J. Fox, S.J. Imm, K. Carroll, A.S. Turk and for the MAPS Investigators
American Journal of Neuroradiology May 2014, 35 (5) 935-942; DOI: https://doi.org/10.3174/ajnr.A3857
C.G. McDougall
aFrom the Department of Neurosurgery (C.G.M.), Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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S. Claiborne Johnston
bClinical and Translational Science Institute (S.C.J.)
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A. Gholkar
dDepartment of Neuroradiology (A.G.), Regional Neurosciences Center, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
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S.L. Barnwell
eDepartments of Neurological Surgery and Diagnostic Radiology (S.L.B.), Oregon Health and Science University, Portland, Oregon
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J.C. Vazquez Suarez
fTherapeutic Neuroradiology Unit (J.C.V.S.), University General Hospital of Alicante, Alicante, Spain
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J. Massó Romero
gDepartment of Interventional Neuroradiology (J.M.R.), Hospital Donostia, San Sebastián, Spain
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J.C. Chaloupka
hDepartment of Neurosurgery and Radiology (J.C.C.), Mount Sinai Medical Center, Miami Beach, Florida
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A. Bonafe
iService de Neuroradiologie (A.B.), Hôspital Gui de Chauliac, Montpellier Cedex, France
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A.K. Wakhloo
jDivision of Neuroimaging and Intervention (A.K.W.), Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
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D. Tampieri
kDepartment of Diagnostic and Interventional Neuroradiology (D.T.), Montreal Neurological Institute, Montreal, Canada
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C.F. Dowd
cDepartment of Radiology (C.F.D.), University of California, San Francisco, San Francisco, California
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A.J. Fox
lDepartment of Neuroradiology (A.J.F.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
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S.J. Imm
mStryker Corporation (S.J.I., K.C.), Fremont, California
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K. Carroll
mStryker Corporation (S.J.I., K.C.), Fremont, California
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A.S. Turk
nDepartments of Neurointerventional Surgery, Radiology, and Neurosurgery (A.S.T.), Medical University of South Carolina, Charleston, South Carolina.
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    Fig 1.

    Subject flow through 455 days.

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    Fig 2.

    Kaplan-Meier curve showing freedom from TAR to 455 days in the intent-to-treat population (n = 626).

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    Table 1:

    Summary of subject baseline characteristicsa

    VariableBMC (n = 315)Matrix2 (n = 311)
    Male104 (33.0%)82 (26.4%)
    Age (yr)54.4 ± 13.255.7 ± 11.6
    Ethnicity and race
        Caucasian/white259 (82.2%)249 (80.1%)
        Black or African American13 (4.1%)12 (3.9%)
        Asian11 (3.5%)13 (4.2%)
        Hispanic or Latino13 (4.1%)16 (5.1%)
        Other19 (6.0%)21 (6.8%)
    Current use of illicit drugs and/or alcohol abuse25 (8.4%)25 (8.6%)
    Hypertension143 (45.5%)153 (49.5%)
    Coronary disease29 (9.4%)44 (14.5%)
    Hyperlipidemia/hypercholesterolemia70 (22.5%)85 (28.0%)
    Intracranial atherosclerosis7 (2.3%)4 (1.3%)
    Current smoking124 (42.6%)117 (41.6%)
    Diabetes19 (6.1%)33 (10.7%)
    Prior stroke or TIA35 (11.2%)31 (10.2%)
    • ↵a Values are presented as mean ± SD for continuous variables and No. (%) for categoric variables. The denominator used for rates (%) can be smaller than the number of subjects in each group due to missing values.

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    Table 2:

    Number of TAR events at 455 days

    SubjectsBMC (No.) (%)Matrix2 (No.) (%)All Subjects (No.) (%)
    Overall315311626
        Subjects who met primary end point35 (11.1)34 (10.9)69 (11.0)
        Re-intervention only33 (10.5)31 (10.0)64 (10.2)
        Ruptures or reruptures2 (0.6)2 (0.6)4 (0.6)a
        Unknown causes of death01 (0.3)1 (0.2)
        Symptomatic TAR3 (1.0)4 (1.3)7 (1.1)
        Symptomatic retreatment2 (0.6)2 (0.6)4 (0.6)
    Unruptured196202398
        Subjects who met primary end point18 (9.2)19 (9.4)37 (9.3)
        Re-intervention only18 (9.2)18 (8.9)36 (9.0)
        Ruptures or reruptures01 (0.5)1 (0.3)b
        Unknown causes of death000
        Symptomatic TAR1 (0.5)2 (1.0)3 (0.8)
        Symptomatic retreatment1 (0.5)2 (1.0)3 (0.8)
    Ruptured119109228
        Subjects who met primary end point17 (14.3)15 (13.8)32 (14.0)
        Re-intervention only15 (12.6)13 (11.9)28 (12.3)
        Ruptures or reruptures2 (1.7)1 (0.9)3 (1.3)c
        Unknown causes of death01 (0.9)1 (0.4)
        Symptomatic TAR2 (1.7)2 (1.8)4 (1.8)
        Symptomatic retreatment1 (0.8)01 (0.4)
    • ↵a Three patients (2 BMC, 1 Matrix2) with a rupture/rerupture also had a subsequent re-intervention.

    • ↵b One patient (Matrix2) with a rupture also had a subsequent re-intervention.

    • ↵c Two patients (BMC) with a rerupture also had a subsequent re-intervention.

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    Table 3:

    Secondary end pointsa

    AssessmentBMC (n = 315)Matrix2 (n = 311)Relative Risk (95% CI)Difference (95% CI)P Value
    Angiographic assessment by core laboratory
        Modified Raymond Scale after procedure
            1) Complete obliteration89 (35.6%)87 (36.6%)0.97 (0.77–1.23)−1.0% (−9.5–7.6).9894
            2) Residual neck/dog ear68 (27.2%)60 (25.2%)1.08 (0.80–1.45)2.0% (−5.8–9.8)
            3) Residual aneurysm93 (37.2%)91 (38.2%)0.97 (0.77–1.22)−1.0% (−9.6–7.6)
        Modified Raymond Scale at 455-day FU or re-intervention
            1) Complete obliteration99 (39.9%)105 (44.3%)0.90 (0.73–1.11)−4.4% (−13.2–4.4).8297
            2) Residual neck/dog ear69 (27.8%)48 (20.3%)1.37 (1.00–1.90)7.6% (0.0–15.1)
            3) Residual aneurysm80 (32.3%)84 (35.4%)0.91 (0.71–1.17)−3.2% (−11.6–5.2)
    Aneurysm change
        Better81 (32.7%)60 (25.4%)1.28 (0.97–1.70)7.2% (−0.8–15.3).1225
        Same82 (33.1%)85 (36.0%)0.92 (0.72–1.17)−3.0% (−11.4–5.5)
        Worse85 (34.3%)91 (38.6%)0.89 (0.70–1.13)−4.3% (−12.9–4.3)
    Neurologic assessment
        Worseb mRS score
            At post-index procedure25 (8.5%)30 (10.5%)0.81 (0.49–1.35)−2.0% (−6.7–2.8).4220
            At 455 days follow-upc33 (11.7%)28 (9.9%)1.19 (0.74–1.92)1.9% (−3.2–7.0).4705
    Technical success
        Technical procedure successd307 (97.5%)301 (96.8%)1.01 (0.98–1.03)0.7% (−1.9–3.3).6130
    • Note:—FU indicates follow-up.

    • ↵a Values are presented as mean ± SD for continuous variables and No. (%) for categoric variables. The denominator used for rates (%) can be smaller than the number of subjects in each group due to missing values.

    • ↵b Compared with the pre-index procedure.

    • ↵c All causes of deaths within 455 days were incorporated as a follow-up mRS score of 6.

    • ↵d Technical success evaluated at the patient level.

    • View popup
    Table 4:

    455-Day TAR rate by the Modified Raymond Scale at immediate postprocedurea

    Modified Raymond ScaleBMCMatrix2Relative Risk (95% CI)Difference (95% CI)P Value
    1) Complete obliteration7.9% (7/89)3.4% (3/87)2.28 (0.61–8.54)4.4% (−2.4–11.2).3297
    2) Residual neck/dog ear11.8% (8/68)1.7% (1/60)7.06 (0.91–54.81)10.1% (1.8–18.4).0358
    3) Residual aneurysm16.1% (15/93)24.2% (22/91)0.67 (0.37–1.20)−8.0% (−19.6–3.5).1733
    • ↵a Values are presented as % (x/N).

    • View popup
    Table 5:

    455-Day TAR predictors by logistic regression modelsa

    VariableCoefficientStandard ErrorOR (95% CI)P Value
    Rupture status (ruptured vs unruptured)1.40.34.0 (2.1–7.9)<.0001
    Core lab postproc Raymond Scale (2 vs 1)0.30.51.4 (0.5–3.7).4917
    Core lab postproc Raymond Scale (3 vs 1)1.60.45.0 (2.2–11.0)<.0001
    Dome sizea (≥10 vs <10 mm)1.60.45.0 (2.2–11.5).0001
    Neck size (≥4 vs <4 mm)0.80.32.3 (1.2–4.4).0140
    • Note:—postproc indicates postprocedural; AP, anteroposterior.

    • ↵a Dome size is calculated as a minimum of the 2 widths (AP plane, lateral plane).

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C.G. McDougall, S. Claiborne Johnston, A. Gholkar, S.L. Barnwell, J.C. Vazquez Suarez, J. Massó Romero, J.C. Chaloupka, A. Bonafe, A.K. Wakhloo, D. Tampieri, C.F. Dowd, A.J. Fox, S.J. Imm, K. Carroll, A.S. Turk, for the MAPS Investigators
Bioactive versus Bare Platinum Coils in the Treatment of Intracranial Aneurysms: The MAPS (Matrix and Platinum Science) Trial
American Journal of Neuroradiology May 2014, 35 (5) 935-942; DOI: 10.3174/ajnr.A3857

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Bioactive versus Bare Platinum Coils in the Treatment of Intracranial Aneurysms: The MAPS (Matrix and Platinum Science) Trial
C.G. McDougall, S. Claiborne Johnston, A. Gholkar, S.L. Barnwell, J.C. Vazquez Suarez, J. Massó Romero, J.C. Chaloupka, A. Bonafe, A.K. Wakhloo, D. Tampieri, C.F. Dowd, A.J. Fox, S.J. Imm, K. Carroll, A.S. Turk, for the MAPS Investigators
American Journal of Neuroradiology May 2014, 35 (5) 935-942; DOI: 10.3174/ajnr.A3857
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