Introduction: The initial experience with the Penumbra Coil 400 (PC400) system has been positive regarding safety, efficacy, improved packing density, and cost effectiveness but follow-up data is limited.
Methods: Seventy-six aneurysms treated with PC400 coils were compared to 301 aneurysms treated with a variety of different bare platinum and bioactively coated coils. In addition to procedural data, immediate and first follow-up occlusion class was compared.
Results: Compared to controls, the PC400 group had fewer coils used (3.53 vs. 5.44, p=0.00190), decreased procedure time (48 min. vs. 64 min., p=0.00016), and increased packing density (31.70% vs. 24.83%, p<0.00001). Compared to controls, there were more grade III (71.05% vs 38.21%, p<0.00001) and fewer grade I aneurysms (13.16% vs 30.23%, p=0.00220) in the PC400 group immediately following the procedure. At first follow-up, however, more aneurysms in the PC400 group improved (51.28% vs 28.71%, p=0.0085) in angiographic grade and fewer worsened (5.13% vs 11.39%, p=0.3882). Both groups had similar rates of acceptable outcome (grade 1 or 2) at first follow-up (PC400 79.49% vs. Control 77.22%). There were fewer retreatments in the PC400 group that approached statistical significance (2.63% vs. 9.30%, p=0.0585).
Conclusions: Compared to control coils, PC400 coils achieve higher packing density with fewer coils and decreased procedure time. Furthermore, although there was a larger number of grade III aneurysms in the PC400 group immediately after the procedure, there was a greater tendency for these aneurysms to improve in angiographic grade at first follow-up leading to similar rates of acceptable outcome.
Patient Care: The goal of this research is to better understand the efficacy of the PC400 system in the treatment of cerebral aneurysms on both a short and long term scale. Interventional neurosurgeons will hopefully be able to use these results to make more informed decisions when choosing coil types during aneurysm embolization.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand how PC400 coils compare to control coils during initial treatment; 2) Understand how PC400 coils compare to control coils at 6 month follow-up specifically regarding aneurysm occlusion class
References: 1) Woo H, Fiorello D, Han P. Preliminary results with a new volumetric-?lling platinum coil, the Penumbra coil 400. J Neurointervent Surg 2011;3:A20.
2) Mascitelli JR, Polykarpou MF, Patel AA, Kamath AA, Moyle H, Patel AB. Initial experience with Penumbra Coil 400 versus standard coils in embolization of cerebral aneurysms: a retrospective review. J Neurointerv Surg. 2012 Sep 19.
3) Milburn J, Pansara AL, Vidal G, Martinez RC. Initial experience using the Penumbra coil 400: comparison of aneurysm packing, cost effectiveness, and coil efficiency. J Neurointerv Surg. 2013 Mar 15.
4) Baxter B, Quarfordt S. Clinical experience and lessons learned with the Penumbra PC. 400 large volume coil: Improving the treatment of both large and small aneurysms. J Neurointervent Surg 2012;4(Suppl 1):A35.
5) Grunwald IQ, Balami JS, Weber D, Mutter J, Kühn AL, Krick C, Reith W, Papanagiotou P, Shariat K. Different factors influence recanalisation rate after coiling in ruptured and unruptured intracranial aneurysms. CNS Neurol Disord Drug Targets. 2013 Mar;12(2):228-32.
6) Byrne J.V., M.J. Sohn, A.J. Molyneux, B. Chir. Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding. J Neurosurg. 90 (1999), pp. 656–663.
7) Ferns SP, Sprengers ME, van Rooij WJ, et al. Coiling of intracranial aneurysms: a systematic review on initial occlusion and reopening and retreatment rates. Stroke. 2009;40:e523–29.
8) Rezek I, Mousan G, Wang Z, Murad MH, Kallmes DF. Coil Type Does Not Affect Angiographic Follow-Up Outcomes of Cerebral Aneurysm Coiling: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol. 2013 May 9. [Epub ahead of print]