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Hydrogel-coated versus bare platinum coils for intracranial aneurysms: a post-HYBRID updated meta-analysis of six
Alperen Elek1, Irshad Allahverdiyev2, Ferhat Kıran1
1Ege University Faculty of Medicine, Department of Radiology, İzmir, Türkiye.
Purpose:
Randomized controlled trials (RCTs) comparing hydrogel-coated coils (HGCs) with bare platinum coils (BPCs) have yielded heterogeneous results, and the clinical relevance of longitudinal angiographic assessment remains uncertain. Following the publication of the HYBRID trial, which emphasized occlusion trajectory rather than static end points, a post-HYBRID updated meta-analysis is warranted to compare angiographic durability and safety outcomes between these coil types.
Methods:
A systematic literature search of MEDLINE, Web of Science, and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RCTs comparing HGCs with BPCs for the treatment of intracranial aneurysms were included.
Results:
Six RCTs comprising 2,486 patients and 2,513 treated intracranial aneurysms were included in the analysis. There was no statistically significant difference between HGCs and BPCs in immediate complete occlusion [risk ratio (RR): 0.87; 95% confidence interval (CI), 0.70-1.09; I²: 63.0%] or immediate adequate occlusion (RR: 0.96; 95% CI, 0.85-1.07; I²: 31.0%). Immediate residual aneurysm was significantly more frequent with HGCs than with BPCs (RR: 1.12; 95% CI, 1.01-1.24; I²: 0.0%; P = 0.041). At the last available angiographic follow-up, complete occlusion, adequate occlusion, and residual neck rates remained comparable between HGCs and BPCs. However, residual aneurysm at follow-up was significantly less frequent with HGCs than with BPCs (RR: 0.75; 95% CI, 0.68-0.83; I²: 0.0%; P = 0.006). HGCs were also associated with a significantly lower rate of major recurrence than BPCs (RR: 0.71; 95% CI, 0.54-0.94; P = 0.024). Safety and clinical outcomes were similar between treatment groups.
Conclusion:
Despite comparable safety and clinical outcomes between HGCs and BPCs, HGCs demonstrated superior angiographic durability, as reflected by lower rates of residual aneurysm and major recurrence.
Clinical Significance:
HGCs may offer improved long-term aneurysm durability compared with BPCs by reducing residual aneurysm and major recurrence without compromising safety or clinical outcomes. These findings support consideration of HGCs when durable occlusion is a priority in endovascular treatment planning for intracranial aneurysms.
