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TARGET® Intracranial Aneurysm Coiling Prospective Multicenter Registry: Final Analysis of Peri-Procedural and

Osama O Zaidat¹, Alicia C Castonguay², Ansaar T Rai³

¹Neuroscience Institute, Bon Secours Mercy Health St. Vincent Hospital, Toledo, OH, United States.

Frontiers in Neurology

|July 25, 2019

Insights

The TARGET Registry shows new generation coils achieve high long-term occlusion rates for intracranial aneurysms, with 90.4% complete or near-complete closure and excellent functional outcomes for patients.

Area of Science:

Neurosurgery
Interventional Neuroradiology
Medical Devices

Background:

Intracranial aneurysms pose significant risks, necessitating effective treatment strategies.
New generation coils are increasingly used for endovascular embolization.
Real-world data is crucial for evaluating treatment efficacy and safety.

Purpose of the Study:

To report the final outcomes of the TARGET Registry, evaluating TARGET Coils in patients with intracranial aneurysms.
To assess the safety and effectiveness of TARGET 360° and helical coils in a real-world setting.
To identify predictors of successful aneurysm occlusion and functional outcomes.

Main Methods:

Prospective, single-arm, multicenter TARGET Registry study.
148 patients with 157 intracranial aneurysms treated with TARGET 360° or helical coils.
Outcomes assessed included packing density, occlusion rates (Raymond Scale), and functional status (modified Rankin Scale).

Main Results:

High rates of long-term occlusion: 90.4% complete or near-complete, 66.2% complete obliteration.
Excellent functional outcomes: 89.9% good outcome (mRS 0-2) at discharge; 94.8% achieved long-term independence.
Low peri-procedural morbidity/mortality (2.7%); all-cause mortality 2%. Predictors of occlusion: location, immediate grade, size.

Conclusions:

TARGET Coils demonstrated high efficacy in achieving long-term aneurysm occlusion in a real-world setting.
The registry confirmed excellent functional outcomes and a favorable safety profile.
This study supports the use of new generation coils for intracranial aneurysm treatment.

Read full analysis

Abstract:

Background and Purpose: To describe the final results of the TARGET Registry, a multicenter, real-world study of patients with intracranial aneurysms treated with new generation TARGET Coils. Methods: The TARGET Registry is a prospective, single-arm study with independent medical event monitoring and core-lab adjudication. Patients with de novo intracranial aneurysms were embolized with either TARGET-360° or helical coils in 12 US centers. The primary outcome was aneurysm packing density (PD), which was assessed immediately post-procedure. The secondary outcomes were immediate and long-term aneurysm occlusion rate using the Raymond Scale, and independent functional outcome using the modified Rankin Scale (mRS). A secondary analysis investigated the influence of the use of 100% 360-complex coils on clinical and angiographic outcomes. Results: 148 patients with 157 aneurysms met the inclusion and exclusion criteria. 58 (39.2%) patients with ruptured and 90 (61.8%) with unruptured aneurysms were treated using TARGET 360°, helical Coils, or both. Median age was 58.3 (IQR 48.1-67.4), 73% female, and 71.6% were Caucasian. Median follow-up time was 5.9 (IQR 4.0-6.9) months. The majority were treated with TARGET 360-coils (63.7%), followed by mixed and helical coils only. Peri-procedural morbidity and mortality was seen in 2.7% of patients. A good outcome at discharge (mRS 0-2) was seen in 89.9% of the full cohort, and in 84.5 and 93.3% in the ruptured and unruptured patients, respectively. The median packing density was 28.8% (IQR 20.3-41.1). Long-term complete and near complete occlusion rate was seen in 90.4% of aneurysms and complete obliteration was seen in 66.2% of the aneurysms. No significant difference in clinical and angiographic outcomes were noted between the pure 360-complex coiling vs. mixed 360-complex/Helical coiling strategies. In a multivariate analysis, predictors for long-term aneurysm occlusion were aneurysm location, immediate occlusion grade, and aneurysm size. The long-term independent functional outcome was achieved in 128/135 (94.8%) patients and all-cause mortality was seen in 3/148 (2%) patients. Conclusion: In the multicenter TARGET Registry, two-thirds of aneurysms achieved long-term complete occlusion and 91.0% achieved complete or near complete occlusion with excellent independent functional outcome. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT01748903.

Keywords:

SAH aneurysm coiling occlusion ruptured aneurysm target coils target registry

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