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E-074 "smart" coils in the treatment of intracranial aneurysms- a retrospective audit of results, device related complications and adverse events
  1. R Padmanabhan
  1. Neuroradiology, James Cook University Hospital, Middlesbrough, UNITED KINGDOM.


Introduction Endosaccular deployment of detachable platinum coils remains the mainstay of endovascular treatment of intracranial aneurysms despite the rapid advances made in other endosaccular and endoluminal devices. Coil technology has evolved rapidly over the last decade and there are now a multitude of bare platinum and coated coils available for use in the treatment of intracranial aneurysms.

Recently, a new range of platinum coils- SMART coil [PENUMBRA] have been introduced, which are designed to become progressively softer during coil deployment, thereby reducing trauma and causing less catheter displacement during delivery into very small aneurysms. They are also reportedly ultra-stretch resistant due to a central core of Ultra HD fibre.

We present a retrospective audit of the intraprocedural complication rates, angiographic results and clinical outcomes of 75 consecutive patients with intracranial aneurysms treated with SMART coils in a single neurosciences centre in NE England from Feb 2016 to Feb 2017.

Materials and methods: Retrospective analysis of the neurovascular database from 19 Feb 2016- 7 Feb 2017 identified 75 patients (with 78 aneurysms) treated with the SMART (PENUMBRA) coil system.

The relevant case notes, angiography, cross-sectional imaging and follow up clinic data was reviewed. In this group of patients we looked at the incidence of intra-procedural complications, the use of adjunctive devices, clinical outcomes, angiographic recurrences.

Results 75 patients (55 Female and 20 male) harbouring 78 intracranial aneurysms were treated with SMART coils.

The age range of patients was from 33–88 years (median 56 years). There were 41 acutely ruptured and 37 unruptured aneurysms (3 neck remnants) comprising of 16 ACOM, 9 Basilar, 4 Carotid cave, 1 ICA Termination, 3Paraophthalmic, 23 MCA, 21 PCOM, 1 SCA aneurysms. Median size of aneurysm treated was 8 MM (Range 2-14mm). There were 13 very small aneurysms (≤ 3mm) treated with SMART extra soft coils.

20 aneurysms were treated purely with the SMART coil range, the other 58 aneurysms were treated with a combination of coils. The total number of SMART coils used was 252 (13 Standard, 27 soft, 212 extra-soft coils)

Adjunctive devices were used in 57 cases (41 balloons and 16 stents).

No coil migration, coil stretching, premature detachment or failure of coil detachment was noted with the SMART coils. 3 coils were retrieved and not detached. There was one intra-procedural rupture (controlled with balloon inflation) and 3 cases of intra-procedural thrombosis treated with IV Absciximab. 3 patients died of presenting SAH and 1 case of delayed procedure related mortality ( remote haemorrhage in stent assisted coiling case). Otherwise there was no change in the baseline mRs of the remaining patients after the procedure.

6 month FU MRA is available in 39/75 patients which reveals complete aneurysm occlusion with no remnants in 32 patients and small neck remnants in 7 patients (under observation).

Conclusion The SMART (PENUMBRA) coil system is safe, easy to use and effective especially in the treatment of otherwise difficult to treat very small intracranial aneurysms. SMART coils are a great new addition to the available range of coils for treatment of intracranial aneurysms.

Disclosures: R. Padmanabhan: 3; C; PENUMBRA.

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