Endovascular Coiling of Cerebral Aneurysms Using “Bioactive” or Coated-Coil Technologies: A Systematic Review of the Literature

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Fig 1.
Data extraction proforma.
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Fig 2.
Incomplete occlusion rate observed with coated coils by comparison with the incomplete occlusion rate expected for a “virtual series” of bare platinum coils in a size-matched aneurysm cohort.

Table 1:

Data extracted from studies meeting primary inclusion criteria

Section/Subsection Category	Weighting (Low/High)
Design, baseline data
No patients, aneurysms in study	L
Clinical status (WFNS)	L
Age/sex demography	L
Aneurysm location	L
Study inclusion/exclusion criteria	H
Consent/ethics described	H
Rupture/unruptured	L
Size composition of aneurysms	L
Procedural data
Coils assessed	L
Exclusive coiling with coated coil	L
Packing density	L
Assist-device usage	H
Detail of procedural complications	H
Procedural angio result	H
Outcome data
Independent angio assessment	H
Independent clinical assessment	H
Proportion with angio follow-up	H
Duration of angio follow-up	L
Detail on clinical tool, results	L
Angio results	H
Rebleed rate	L
Aneurysm retreatment rate	H

Note:—H indicates high; L, lower weighting; WFNS, World Federation of Neurosurgeons.

Table 3:

Principal aneurysm demographic data and procedural safety results

	PGLA Coated	Hydrogel Coated	PGA Coated	Fibered
	Num/Denom (%)	Num/Denom (%)	Num/Denom (%)	Num/Denom (%)
Ruptured aneurysms	728/1215(60)	353/720 (49)	98/123 (80)	DNE
Aneurysm size	Given in 11/14 studies	Given in 6/10 studies	Given in 1/2 studies	474 aneurysms
Small/medium (<10 mm)	745/899 (82.9)	233/343 (68)	67/68 (98.5)	99 < 5 mm (23.5)
Large (10–25 mm)	149/899 (16.6)	92/343 (27)	1/68 (1.5)	316 = 5–25 mm (75.1)
Giant (>25 mm)	5/899 (0.6)	18/343 (5)	0/123 (0)	6 (1.4)
Overall assist device use	215/957 (22)	132/576 (23)	DNE	DNE
Stent	113/942 (12)	50/132 (9)	5/123 (4)	NS
Balloon	102/957 (11)	81/132 (14)	NS	NS
Other	0/957 (0)	1 (0.2)	NS	NS
Procedure-related morbidity, mortality rate	53/1199 (4.7)	20/687 (2.9)	3/67 (4.5)	25/463 (5.4)
Permanent procedural morbidity	41/1199 (3.4)	18/687 (2.6)	0/67 (0)	18/463 (3.9)
Procedure-related mortality	12/1199 (1.1)	2/687 (0.3)	3/67 (4.5)	7/463 (1.5)
Aneurysm perforation	29/1215 (2.5)	9/720 (1.3)	3/67 (4.5)	NS
Thromboembolic event	129/1215 (10.6)	50/720 (6.9)	12/123 (9.8)	38/474 (8)
Hydrocephalus	NS	10/285 (3.5)	NS	NS

Note:—Num/Denom indicates numerator/denominator; NS, not stated; DNE, data not extractable.

Table 4:

Angiographic outcomes

Procedural Angio Result	PGLA Coated	Hydrogel Coated	PGA Coated	Fibered
Procedural Angio Result	Num/Denom (%)	Num/Denom (%)	Num/Denom (%)	Num/Denom (%)
Montreal grade 1 or 2	946/1178 (80)	614/716 (86)	120/123 (98)	452/476 (95)
Montreal grade 3	232/1178 (20)	102/716 (14)	t3/123 (2)	22/476 (5)
Proportion with angio control	668/1215 (55)	490/720 (71)	101/123 (82)	156/474 (33)
Mean duration of follow-up	7.6 (months)	7.5 (months)	6 (months)	6 (months)
Control angio result
Montreal grade 1 or 2	503/668 (75)	407/490 (83)	91/101 (90)	(71) grade 1
Montreal grade 3	165/668 (25)	83/490 (17)	10/101 (10)	(29) grade 2/3

Table 5:

Outcomes

	PGLA Coated	Hydrogel Coated	PGA Coated	Fibered
	Num/Denom (%)	Num/Denom (%)	Num/Denom (%)	Num/Denom (%)
Clinical outcome reported	8/14 studies	2/10 studies	0/2 studies	1/1
Good outcome rate	307/495 (62)	58/63 (92)	NS	353/463 (76)
Rebleeds	7 in 8 studies	3 in 9 studies	0 in 2 studies	NS
Rebleed rate (% pa)	7 in 432 years of follow-up (1.6)	3 in 256 years of follow-up (1.2)	0 in 51 years of follow-up (0)	NS
Aneurysm retreatment	63 in 8 studies	13 in 7 studies	1 in 1 study	DNE
By total aneurysms	63/634 (10)	13/400 (3)	1/55 (2)
By aneurysms followed up	63/472 (13)	13/268 (5)	1/55 (2)