PT  - JOURNAL ARTICLE
AU  - C.G. McDougall
AU  - S. Claiborne Johnston
AU  - A. Gholkar
AU  - S.L. Barnwell
AU  - J.C. Vazquez Suarez
AU  - J. Massó Romero
AU  - J.C. Chaloupka
AU  - A. Bonafe
AU  - A.K. Wakhloo
AU  - D. Tampieri
AU  - C.F. Dowd
AU  - A.J. Fox
AU  - S.J. Imm
AU  - K. Carroll
AU  - A.S. Turk
AU  - for the MAPS Investigators
TI  - Bioactive versus Bare Platinum Coils in the Treatment of Intracranial Aneurysms: The MAPS (Matrix and Platinum Science) Trial
AID  - 10.3174/ajnr.A3857
DP  - 2014 May 01
TA  - American Journal of Neuroradiology
PG  - 935--942
VI  - 35
IP  - 5
4099  - http://www.ajnr.org/content/35/5/935.short
4100  - http://www.ajnr.org/content/35/5/935.full
SO  - Am. J. Neuroradiol.2014 May 01; 35
AB  - BACKGROUND AND PURPOSE: The ability of polymer-modified coils to promote stable aneurysm occlusion after endovascular treatment is not well-documented. Angiographic aneurysm recurrence is widely used as a surrogate for treatment failure, but studies documenting the correlation of angiographic recurrence with clinical failure are limited. This trial compares the effectiveness of Matrix2 polyglycolic/polylactic acid biopolymer–modified coils with bare metal coils and correlates the angiographic findings with clinical failure (ie, target aneurysm recurrence), a composite end point that includes any incident of posttreatment aneurysm rupture, retreatment, or unexplained death. MATERIALS AND METHODS: This was a multicenter randomized noninferiority trial with blinded end point adjudication. We enrolled 626 patients, divided between Matrix2 and bare metal coil groups. The primary outcome was target aneurysm recurrence at 12 ± 3 months. RESULTS: At 455 days, at least 1 target aneurysm recurrence event had occurred in 14.6% of patients treated with bare metal coils and 13.3% of Matrix2 (P = .76, log-rank test) patients; 92.8% of target aneurysm recurrence events were re-interventions for aneurysms that had not bled after treatment, and 5.8% of target aneurysm recurrence events resulted from hemorrhage or rehemorrhage, with or without retreatment. Symptomatic re-intervention occurred in only 4 (0.6%) patients. At 455 days, 95.8% of patients with unruptured aneurysms and 90.4% of those with ruptured aneurysms were independent (mRS ≤ 2). Target aneurysm recurrence was associated with incomplete initial angiographic aneurysm obliteration, presentation with rupture, and a larger aneurysmal dome and neck size. CONCLUSIONS: Tested Matrix2 coils were not inferior to bare metal coils. Endovascular coiling of intracranial aneurysms was safe, and the rate of technical success was high. Target aneurysm recurrence is a promising clinical outcome measure that correlates well with established angiographic measurements. BMCbare metal coilHELPSHydroCoil Endovascular Aneurysm Occlusion and Packing StudyISATInternational Subarachnoid Aneurysm TrialMAPSMatrix and Platinum ScienceTARtarget aneurysm recurrence