PT  - JOURNAL ARTICLE
AU  - W. Brinjikji
AU  - P.M. White
AU  - H. Nahser
AU  - J. Wardlaw
AU  - R. Sellar
AU  - A. Gholkar
AU  - H.J. Cloft
AU  - D.F. Kallmes
TI  - HydroCoils Are Associated with Lower Angiographic Recurrence Rates Than Are Bare Platinum Coils in Treatment of “Difficult-to-Treat” Aneurysms: A Post Hoc Subgroup Analysis of the HELPS Trial
AID  - 10.3174/ajnr.A4349
DP  - 2015 Sep 01
TA  - American Journal of Neuroradiology
PG  - 1689--1694
VI  - 36
IP  - 9
4099  - http://www.ajnr.org/content/36/9/1689.short
4100  - http://www.ajnr.org/content/36/9/1689.full
SO  - Am. J. Neuroradiol.2015 Sep 01; 36
AB  - BACKGROUND AND PURPOSE: The HydroCoil Endovascular Aneurysm Occlusion and Packing Study was a randomized controlled trial that compared HydroCoils to bare platinum coils. Using data from this trial, we performed a subgroup analysis of angiographic and clinical outcomes of patients with “difficult-to-treat” aneurysms, defined as irregularly shaped and/or having a dome-to-neck ratio of <1.5.MATERIALS AND METHODS: Separate subgroup analyses comparing outcomes of treatment with HydroCoils to that of bare platinum coils were performed for the following: 1) irregularly shaped aneurysms, 2) regularly shaped aneurysms, 3) aneurysms with a dome-to-neck ratio of <1.5, and 4) aneurysms with a dome-to-neck ratio of ≥1.5. For each subgroup analysis, the following outcomes were studied at the last follow-up (3–18 months): 1) any recurrence, 2) major recurrence, 3) re-treatment, and 4) an mRS score of ≤2. Multivariate logistic regression analysis was performed to determine if the HydroCoil was independently associated with improved outcomes in these subgroups.RESULTS: Among the patients with an irregularly shaped aneurysm, the HydroCoil was associated with lower major recurrence rates than the bare platinum coils (17 of 66 [26%] vs 30 of 69 [44%], respectively; P = .046). Among the patients with an aneurysm with a small dome-to-neck ratio, the HydroCoil was associated with lower major recurrence rates than the bare platinum coils (18 of 73 [24.7%] vs 32 of 76 [42.1%], respectively; P = .02). No difference in major recurrence was seen between HydroCoils and bare platinum coils for regularly shaped aneurysms (42 of 152 [27.6%] vs 52 of 162 [32.1%], respectively; P = .39) or aneurysms with a large dome-to-neck ratio (41 of 145 [28.3%] vs 50 of 155 [32.3%], respectively; P = .53).CONCLUSIONS: This unplanned post hoc subgroup analysis found that HydroCoils are associated with improved angiographic outcomes in the treatment of irregularly shaped aneurysms and aneurysms with a dome-to-neck ratio of <1.5. Because this was a post hoc analysis, these results are not reliable and absolutely should not alter clinical practice but, rather, may inform the design of future randomized controlled trials.D/Ndome-to-neck ratioHELPSHydroCoil Endovascular Aneurysm Occlusion and Packing Study