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  • Early results of the Axium MicroFX for Endovascular Repair of IntraCranial Aneurysm (AMERICA) study: a multicenter prospective observational registry

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Hemorrhagic stroke
Original Research
Early results of the Axium MicroFX for Endovascular Repair of IntraCranial Aneurysm (AMERICA) study: a multicenter prospective observational registry
  1. Kyle M Fargen1,
  2. Spiros Blackburn1,
  3. Jeffrey S Carpenter2,
  4. Pascal Jabbour3,
  5. William J Mack4,
  6. Ansaar T Rai2,
  7. Adnan H Siddiqui5,
  8. Raymond D Turner6,
  9. J Mocco7
  1. 1Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
  2. 2Department of Radiology, West Virginia School of Medicine, Morgantown, West Virginia, USA
  3. 3Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  4. 4Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
  5. 5Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
  6. 6Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  7. 7Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, USA
  1. Correspondence to Dr Kyle M Fargen, Department of Neurosurgery, University of Florida, Box 100265, Gainesville, FL 32610, USA; kyle.fargen{at}neurosurgery.ufl.edu

Abstract

Background Axium MicroFX coils contain polymer (polyglycolic/polylactic acid, PGLA) microfilaments designed to significantly impact intra-aneurysmal flow and to encourage aneurysm thrombosis. To provide preliminary evaluation of the safety and suggested efficacy of the MicroFX design, we performed a multicenter prospective single-arm trial, Axium MicroFX for Endovascular Repair of IntraCranial Aneurysm study (AMERICA).

Methods AMERICA is a prospective multicenter 100 aneurysm observational study evaluating the safety and efficacy of Axium MicroFX PGLA coils. Enrollment was started in April 2010 and completed in October 2012.

Results 99 patients underwent treatment for 100 aneurysms at 13 centers. Mean age was 60.2 years, most were women (72%) and 18% of patients had previously undergone treatment for a separate aneurysm. 22% of patients underwent treatment after acute aneurysmal subarachnoid hemorrhage (SAH). Of these patients, all were Hunt and Hess grade 1–3. Pre-procedure modified Rankin score (mRS) was 0–2 in 92% of patients. The majority of aneurysms were anterior circulation (86%), with the most common aneurysm locations being the anterior communicating artery (23%) followed by the supraclinoid internal carotid artery and posterior communicating artery (18% each). The mean maximum diameter was 6.5 mm. Axium MicroFX coils could be placed in all but one treatment (99%). Raymond grade at conclusion of coiling was I (complete) in 52%, II (dog ear or residual neck) in 33% and III (residual aneurysm) in 15%. Discharge mRS was significantly worse in patients with SAH (62% mRS 0–2) compared with electively treated aneurysms (mRS 0–2 in 94%, p<001). Major events were uncommon (6% thromboembolic events, 3% intraoperative vessel or aneurysm rupture) and device-related adverse events (AE) were rare (2% of cases).

Conclusions This prospective study of Axium MicroFX coils demonstrates excellent aneurysm occlusion rates. 52% of aneurysms were completely occluded post-procedure. Within the ruptured aneurysm group, post-procedure occlusion rates were 63.6%. Major AE rates were consistent with historical data.

  • Aneurysm
  • Coil
  • Subarachnoid

https://doi.org/10.1136/neurintsurg-2013-010887

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