The Hydrogel Endovascular Aneurysm Treatment Trial (HEAT): A Randomized Controlled Trial of the Second-Generation Hydrogel Coil

Bernard R. Bendok, Karl R. Abi-Aad, Jennifer D. Ward, Jason F. Kniss, Mary J. Kwasny, Rudy J. Rahme, Salah G. Aoun, Tarek Y. El Ahmadieh, Najib E. El Tecle, Samer G. Zammar, Rami James N. Aoun, Devi P. Patra, Sameer A. Ansari, Jean Raymond, Henry H. Woo, David Fiorella, Guilherme Dabus, Genevieve Milot, Josser E. Delgado Almandoz, John A. ScottAndrew J. Denardo, Shervin R. Dashti, Sameer Ansari, Eric Deshaies, Sean Lavine, Hormozd Bozorgchami, Josser Delgado, Erol Veznedaroglu, Felipe Albuquerque, David Fiorella, Alan Boulos, Maria Cortes, Hilal Kanaan, Gaurav Jindal, Richard Klucznik, Guilherme Dabus, David Kalmes, Rabih Tawk, Jean Raymond, Charles Romero, Andrew Xavier, Muhammad Hussain, Michael Kelly, Christopher Moran, Imran Chaudry, Aditya Pandey, Dennis Wang, Brian Van Adel, Genevieve Milot, Joshua Hirsch, Jeffrey Carpenter, Ciaran Powers, Pascal Jabbour, George Luh, Jai Shankar, Ramanchandra Tummala, Athos Patsalides, Avery Evans, Ankur Garg, Shervin Dashti, Sung Lee, Roberts James, Mahesh Jayaraman, Sudhakar Satti, Eric Sauvageau, Jeremy Fields, Thomas Grobelny, Johnathan Hartman

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

BACKGROUND: Aneurysm recurrence after coiling has been associated with aneurysm growth, (re)hemorrhage, and a greater need for follow-up. The second-generation HydroCoil Embolic System (HES; MicroVention, Inc) consists of a platinum core with integrated hydrogel and was developed to reduce recurrence through enhancing packing density and healing within the aneurysm. OBJECTIVE: To compare recurrence between the second-generation HES and bare platinum coil (BPC) in the new-generation Hydrogel Endovascular Aneurysm Treatment Trial (HEAT). METHODS: HEAT is a randomized, controlled trial that enrolled subjects with ruptured or unruptured 3- to 14-mm intracranial aneurysms amenable to coiling. The primary endpoint was aneurysm recurrence using the Raymond-Roy scale. Secondary endpoints included minor and major recurrence, packing density, adverse events related to the procedure and/or device, mortality, initial complete occlusion, aneurysm retreatment, hemorrhage from target aneurysm during follow-up, aneurysm occlusion stability, and clinical outcome at final follow-up. RESULTS: A total of 600 patients were randomized (HES, n = 297 and BPC, n = 303), including 28% with ruptured aneurysms. Recurrence occurred in 11 (4.4%) subjects in the HES arm and 44 (15.4%) subjects in the BPC arm (P =. 002). While the initial occlusion rate was higher with BPC, the packing density and both major and minor recurrence rates were in favor of HES. Secondary endpoints including adverse events, retreatment, hemorrhage, mortality, and clinical outcome did not differ between arms. CONCLUSION: Coiling of small-to-medium aneurysms with second-generation HES resulted in less recurrence when compared to BPC, without increased harm. These data further support the use of the second-generation HES for the embolization of intracranial aneurysms. Video Abstract: 10.1093/neuros/nyaa006 nyaa006Media1 6132264784001

Original languageEnglish (US)
Pages (from-to)615-624
Number of pages10
JournalNeurosurgery
Volume86
Issue number5
DOIs
StatePublished - May 1 2020

Keywords

  • Bare platinum coil
  • Coil embolization
  • Endovascular
  • HydroCoil Embolic System
  • Intracranial aneurysm
  • Randomized controlled trial

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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