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Research ArticleLevel 1 EBM Expedited Publication
Open Access

Patients Prone to Recurrence after Endovascular Treatment: Periprocedural Results of the PRET Randomized Trial on Large and Recurrent Aneurysms

J. Raymond, R. Klink, M. Chagnon, S.L. Barnwell, A.J. Evans, J. Mocco, B.L. Hoh, A.S. Turk, R.D. Turner, H. Desal, D. Fiorella, S. Bracard, A. Weill, F. Guilbert and D. Roy on behalf of the PRET Collaborative Group
American Journal of Neuroradiology September 2014, 35 (9) 1667-1676; DOI: https://doi.org/10.3174/ajnr.A4035
J. Raymond
aFrom the Department of Radiology (J.R., A.W., F.G., D.R.), Centre Hospitalier de l'Université de Montréal
bLaboratory of Interventional Neuroradiology (J.R., R.K.), Centre de recherche du Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada
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R. Klink
bLaboratory of Interventional Neuroradiology (J.R., R.K.), Centre de recherche du Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada
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M. Chagnon
cDépartement de mathématiques et de statistique (M.C.), Université de Montréal, Montreal, Quebec, Canada
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S.L. Barnwell
dDepartment of Neurological Surgery (S.L.B.), Oregon Health & Science University, Portland, Oregon
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A.J. Evans
eDepartment of Radiology and Medical Imaging (A.J.E.), University of Virginia Health System, Charlottesville, Virginia
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J. Mocco
fDepartment of Neurosurgery (J.M., B.L.H.), University of Florida, Gainesville, Florida
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B.L. Hoh
fDepartment of Neurosurgery (J.M., B.L.H.), University of Florida, Gainesville, Florida
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A.S. Turk
gDepartments of Radiology and Neurosurgery (A.S.T., R.D.T.), Medical University of South Carolina, Charleston, South Carolina
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R.D. Turner
gDepartments of Radiology and Neurosurgery (A.S.T., R.D.T.), Medical University of South Carolina, Charleston, South Carolina
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H. Desal
hService de Neuroradiologie Diagnostique et Interventionnelle (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes, France
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D. Fiorella
iDepartment of Neurological Surgery (D.F.), Stony Brook University Medical Center, Stony Brook, New York
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S. Bracard
jDépartement de Neuroradiologie Diagnostique et Interventionnelle (S.B.), Centre Hospitalier Universitaire de Nancy, Nancy, France.
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A. Weill
aFrom the Department of Radiology (J.R., A.W., F.G., D.R.), Centre Hospitalier de l'Université de Montréal
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F. Guilbert
aFrom the Department of Radiology (J.R., A.W., F.G., D.R.), Centre Hospitalier de l'Université de Montréal
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D. Roy
aFrom the Department of Radiology (J.R., A.W., F.G., D.R.), Centre Hospitalier de l'Université de Montréal
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    Fig 1.

    Recruitment. Notice how recruitment decreased progressively from December 2010 to December 2013, a possible sign of case selection.

  • Fig 2.
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    Fig 2.

    Flow chart. Diagram shows patient flow from randomization to periprocedural safety end points.

Tables

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    Table 1:

    Morbidity and mortality adjudicated per patient

    PRET-1PRET-2PRET
    PlatinumHydrogelPlatinumHydrogelPlatinumHydrogel
    Death
        Total02 (1.6%)0002 (0.9%)
        Treatment-related000000
    Morbidity (mRS > 2)
        Total11 (8.8%)5 (4.0%)2 (2.1%)5 (5.0%)13 (5.9%)10 (4.4%)
        Treatment-related5 (4.0%)2 (1.6%)1 (1.0%)2 (2.0%)6 (2.7%)4 (1.8%)
    Any stroke11 (8.8%)5 (4.0%)8 (8.2%)9 (9.0%)19 (8.6%)14 (6.2%)
    Any complication8 (6.4%)4 (3.2%)1 (1.0%)2 (2.0%)9 (4.1%)6 (2.7%)
    No complication95 (76.0%)107 (85.6%)86 (88.7%)83 (83.0%)181 (81.5%)190 (84.4%)
    Withdrawn02 (1.6%)01 (1.0%)03 (1.3%)
    Fisher exact test P value.052.612.174
    • View popup
    Table 2:

    Safety indices reported at time of the procedure and during follow-up

    PRET-1PRET-2PRET
    PlatinumHydrogelPlatinumHydrogelPlatinumHydrogel
    Procedural complications
        Thromboembolic10 (8.0%)6 (4.9%)1 (1.0%)3 (3.0%)11 (5.0%)9 (4.1%)
        Hemorrhagic2 (1.6%)1 (0.8%)1 (1.0%)1 (1.0%)3 (1.4%)2 (0.9%)
        Other4 (3.2%)6 (4.9%)4 (4.1%)3 (3.0%)8 (3.6%)9 (4.1%)
    Anti-GP IIb/IIIa used during embolization8 (6.4%)11 (8.9%)7 (7.2%)4 (4.0%)15 (6.8%)15 (6.8%)
    Clinical deterioration at end of procedure5 (4.0%)1 (0.8%)2 (2.1%)3 (3.0%)7 (3.2%)4 (1.9%)
    Hospitalization
        Days (median) (min) (max)2 (1) (94)1 (0) (70)1 (0) (51)1 (0) (30)1 (0) (94)1 (0) (70)
        Days >5 for unruptured aneurysms9 (7.2%)7 (5.7%)5 (5.2%)5 (5.1%)14 (6.3%)12 (5.4%)
        Days >15 for ruptured aneurysms10 (8.0%)10 (8.1%)1 (1.0%)011 (5.0%)10 (4.5%)
    New imaging findings at discharge17 (13.6)11 (8.9%)7 (7.2%)9 (9.1%)24 (10.8%)20 (9.0%)
    mRS >2 at discharge17 (13.6%)9 (7.3%)1 (1.0%)5 (5.1%)18 (8.1%)14 (6.3%)
    Discharge destination
        Home107 (85.6%)108 (87.8%)95 (97.9%)92 (92.9%)202 (91.0%)200 (90.1%)
        Other than home18 (14.4%)15 (12.2%)2 (2.1%)7 (7.1%)20 (9.0%)22 (9.2%)
    mRS >2 at 1 month11 (8.8%)6 (4.9%)3 (3.1%)5 (5.1%)14 (6.3%)11 (5%)
    Location at 1 month
        Home117 (93.6%)116 (94.3%)95 (97.9%)95 (96.0%)212 (95.5%)211 (95.0%)
        Other than home8 (6.4%)7 (5.7%)2 (2.1%)4 (4.0%)10 (4.5%)11 (5%)
    AE
        No. reported16187102328
        No. (%) serious10 (62%)8 (44.4%)3 (42.9%)6 (60%)13 (56.5%)14 (50%)
    AE attribution (No.) (% of total No. reported)
        Related to treatment14 (87.5%)14 (77.8%)7 (100%)10 (100%)21 (91.3%)24 (85.7%)
        Related to aneurysm2 (12.5%)3 (16.7%)002 (8.7%)3 (10.7%)
        Unrelated01 (5.5%)0001 (3.6%)
    • Note:—Anti-GP IIb/IIIa indicates antiglycoprotein IIb/IIIa; AE, adverse events; min, minimum; max, maximum.

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    Table 3:

    Operator-assessed immediate angiographic results

    PRET-1PRET-2PRET
    PlatinumHydrogelPlatinumHydrogelPlatinumHydrogel
    No coiling, for any reason3 (2.4%)3 (2.4%)05 (5.0%)3 (1.4%)8 (3.6%)
    Residual aneurysm32 (25.6%)39 (31.2%)12 (12.4%)14 (14.0%)44 (19.8%)53 (23.6%)
    Residual neck48 (38.4%)48 (38.4%)40 (41.2%)40 (40.0%)88 (39.6%)88 (39.1%)
    Complete obliteration42 (33.6%)35 (28.0%)45 (46.4%)41 (41.0%)87 (39.2%)76 (33.8%)
    Fisher exact test P value.723.151.280
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American Journal of Neuroradiology: 35 (9)
American Journal of Neuroradiology
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1 Sep 2014
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J. Raymond, R. Klink, M. Chagnon, S.L. Barnwell, A.J. Evans, J. Mocco, B.L. Hoh, A.S. Turk, R.D. Turner, H. Desal, D. Fiorella, S. Bracard, A. Weill, F. Guilbert, D. Roy
Patients Prone to Recurrence after Endovascular Treatment: Periprocedural Results of the PRET Randomized Trial on Large and Recurrent Aneurysms
American Journal of Neuroradiology Sep 2014, 35 (9) 1667-1676; DOI: 10.3174/ajnr.A4035

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Patients Prone to Recurrence after Endovascular Treatment: Periprocedural Results of the PRET Randomized Trial on Large and Recurrent Aneurysms
J. Raymond, R. Klink, M. Chagnon, S.L. Barnwell, A.J. Evans, J. Mocco, B.L. Hoh, A.S. Turk, R.D. Turner, H. Desal, D. Fiorella, S. Bracard, A. Weill, F. Guilbert, D. Roy
American Journal of Neuroradiology Sep 2014, 35 (9) 1667-1676; DOI: 10.3174/ajnr.A4035
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