1112. Hydrogel Coiling Versus Bare Platinum Coiling of Aneurysms: The Neuroinflammatory Response and Its Role in Dampening Recurrence and Rebleeding Rates Among Conventionally Treated Cohorts

Authors: Mansour Hassan Mathkour, MD; Mansour Mathkour, MD, MSc; Erin McCormack, MD; Aaron S. Dumont, MD; Peter S. Amenta, MD; Ricky Medel, MD (Kenner, LA)

Introduction: The treatment of intracranial aneurysms (IA) has undergone a paradigm shift since the introduction of endovascular coil embolization. While microsurgical clipping once represented the mainstay of therapy, coiling has been shown to reduce morbidity and mortality as well as incidence of vasospasm in appropriately selected patients. The major risk associated with the procedure is recurrence, and numerous studies have thus investigated coil alterations that result in optimal primary occlusion and reduced angiographic recurrence rates when compared to those associated with conventional platinum coils. Methods: In this review, we provide an extensive discussion of the most current literature comparing the role of neuroinflammation in aneurysm recurrence of patients coiled using Hydrogel and bare platinum coils. Results: Based on our review of the literature, Hydrogel has proven to be superior to bare platinum metal coils in reducing angiographic recurrence of IA after coil embolization. This effect is mediated by the expansile and “space-seeking” nature of the hydrogel coating embedded in the coils, as well as by an enhanced impact on the inflammatory microenvironment during the formation of the coil-clot complex. Complications associated with these coils are rare and do not obviate use given statistically significant evidence of a nearly two-thirds reduction in risk of recurrence when compared to the use of bare metal coils. Conclusion: We propose that HydroCoil hydrogel-coated coils (Microvention, CA) provide superior primary occlusion rates and reduced angiographic recurrence rates when compared to conventional bare metal coils. We suspect that this is due both to an increased packing density as well as an enhanced impact on the inflammatory cascade that generates the coil-clot complex and ultimately mediates both primary and long-term occlusion rates.