Objectives: The HydroSoft and HydroFrame coils are a new generation of coils designed to further improve the safety and durability of aneurysm coiling using hydrogel technology. The authors report their experience using the HydroSoft and HydroFrame coils for the treatment of intracranial aneurysms. Methods: Immediate and follow-up angiographic results, procedure-related complications, and retreatments were retrospectively analyzed for 106 intracranial saccular aneurysms in 103 patients treated with the HydroSoft and HydroFrame coils during a 50-month period. Results: The incidence of thromboembolic complications was 5.7%. Procedure-related morbidity and mortality rates were each 0.9%. None of the patients with unruptured aneurysms developed hydrocephalus. Immediate post-procedure angiograms showed complete aneurysm occlusion in 34.9% of cases, neck remnant in 36.8%, and incomplete occlusion in 28.3%. Angiographic follow-up was obtained in 51.9% (55 of 106 aneurysms; average, 16 months; range, 6-45 months). In these 55 aneurysms, the rate of immediate complete occlusion was 27.3% after treatment, which increased to 50.9% on follow-up, and the overall recanalization rate was 14.5%. No recanalization was observed in the 8 aneurysms treated with stent-assisted coiling in combination with HydroSoft and HydroFrame coil placement. Conclusions: The overall safety profile of the HydroSoft and HydroFrame coils appears to be acceptable. Preliminary midterm observation suggests that these new-generation hydrogel coils will improve the durability of angiographic occlusion, when compared with immediate post-embolization results, and can reduce the rate of aneurysm recanalization.
Objectives: In recent years, endovascular treatment, especially parent artery occlusion, has become a first-line treatment for ruptured vertebral artery dissecting aneurysms (VADAs). This study reports the outcomes of endovascularly treated ruptured VADAs. Methods: The subjects comprised 50 patients who underwent endovascular parent artery occlusion of ruptured VADAs between 2004 and 2011 (29 men, 21 women; mean age, 50.7 years [range, 28-74 years]). Hunt and Hess (H/H) grades just prior to endovascular treatment were grade 1 in 4 patients (8.0%), grade 2 in 8 (16.0%), grade 3 in 14 (28.0%), grade 4 in 9 (18.0%), and grade 5 in 15 (30.0%). Clinical outcomes were assessed using the Glasgow Outcome Scale. Locations of dissecting aneurysms relative to the ipsilateral posterior inferior cerebellar artery (PICA) were proximal type in 3 patients (6.0%), distal type in 25 (50.0%), PICA-involved type in 6 (12.0%), and non-PICA type in 16 (32.0%). Results: Forty-two patients (84.0%) underwent internal trapping, and the remaining 8 patients (16.0%) underwent proximal occlusion. One patient rebled during the diagnostic angiography before the coil embolization procedure. There were no procedure-related complications. Clinical outcomes at discharge were good recovery in 26 patients (52.0%), moderate disability in 4 (8.0%), severe disability in 10 (20.0%), vegetative survival in 4 (8.0%), and death in 6 (12.0%). Notably, 41.5% of the patients with an H/H grade of 4 to 5 had a good clinical outcome. Conclusions: This study shows that endovascular parent artery occlusion for ruptured VADAs is feasible and safe.