Citations 2
The Hydrogel Endovascular Aneurysm Treatment Trial (HEAT): A Randomized Controlled Trial of the Second-Generation Hydrogel Coil
Bendok, Bernard R. , Abi-Aad, Karl R., Ward, Jennifer , Kniss, Jason F , Kwasny, Mary , Rahme, Rudy J. , Aoun, Salah G. , Tecle, Najib E. El , Zammar, Samer G. , Aoun, Rami James N. , Patra, Devi Prasad, Raymond, Jean , Woo, Henry H. , Dabus, Guilherme , Milot, Geneviève , Scott, John A. , DeNardo, Andrew , Investigators, HEAT Study, Lavine, Sean D., Bozorgchami, Hormozd, Veznedaroglu, Erol, Albuquerque, Felipe C. , Fiorella, David, Boulos, Alan S. , Cortes, Maria, Kanaan, Hilal, Jindal, Gaurav , Klucznik, Richard , Kalmes, David, Xavier, Andrew, Hussain, Muhammad , Moran, Christopher J. , Adel, Brian van , Milot, Genevieve, Hirsch, Joshua A , Carpenter, Jeffrey , Powers, Ciarán J. , Luh, George, Tummala, Ramanchandra, Evans, Avery J. , Garg, Ankur, James, Roberts, Sauvageau, Eric , Fields, Jeremy D. , Grobelny, Thomas, Hartman, J., Patra, Devi P. , Bendok, Bernard R , Ward, Jennifer D, Ahmadieh, Tarek Y. El , Ansari, Sameer A. , Fiorella, David , Dabus, Guilherme C. , Almandoz, Josser E Delgado , Dashti, Shervin R , Investigators, HEAT Study, Deshaies, Eric Michael , Fiorella, David, Tawk, Rabih G. , Romero, Charles, Kelly, Michael , Chaudry, Imran , Pandey, Aditya S , Wang, Dennis Y.Q. , Milot, Genevieve, Jabbour, Pascal , Shankar, Jai , Patsalides, Athos T , Lee, Sung , James, Robert F. , Jayaraman, Mahesh V. , Satti, Sudhakar R
Neurosurgery | February 10, 2020 | Volume: 86 | Issue: 5 | Pages: 615-624
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
REACH
Hess, David C. , Wang, Samuel J. , Hamilton, William , Pardue, Carol, Waller, Jennifer L. , Gross, Hartmut, Nichols, Fenwick T. , Hall, Christiana E., Adams, Robert J. , Lee, Sung
Stroke | July 28, 2005 | Volume: 36 | Issue: 9 | Pages: 2018-2020
10.1161/01.str.0000177534.02969.e4
Background and Purpose— Development of stroke networks is critical to bringing guideline-driven stroke care to rural, underserved areas. Methods— A Web-based telestroke tool, REACH, was developed to provide a foundation for a rural stroke network that delivered acute stroke consults 24 hours per day 7 days per week to 8 rural community hospitals in Georgia. Results— There were 194 acute stroke consults delivered. Thirty patients were treated with tissue plasminogen activator (tPA). The mean National Institutes of Health Stroke Score (NIHSS) was 15.4, and the median NIHSS was 12.5. The mean onset to treatment time (OTT) was 122 minutes. The OTT dropped from 143 minutes in the first 10 patients treated to 111 minutes in last 20 patients. Of the 30 patients treated with tPA, 23% (7) were treated in ≤90 minutes and 60% (18) were treated within 2 hours. There were no symptomatic intracerebral hemorrhages. Conclusions— The REACH telestroke system permits the rapid and safe use of tPA in rural community hospitals. Over time, the system became more efficient and OTT decreased.