LARGE Aneurysm Randomized Trial: Flow Diversion Versus Traditional Endovascular Coiling Therapy

Medical University of South Carolina (MUSC)

Status and phase

Terminated

Phase 4

Conditions

Intracranial Aneurysm

Treatments

Procedure: Flow Diversion

Procedure: Coiling

Study type

Interventional

Funder types

Other

Identifiers

NCT01762137

PRO18426

Details and patient eligibility

About

In this study, patients with large anterior circulation IAs with neck and fundus morphologies amenable to either traditional endovascular treatments using coils or reconstruction with the flow diversion will be randomly assigned to either treatment technique.

Full description

This is a prospective, randomized trial comparing the endovascular coiling (endovascular coiling) versus the flow diversion for large and giant aneurysm treatment. The endovascular coiling used in this study are FDA-approved and in common use at institutions in this country and across the world. The flow diversion devices are FDA-approved for anterior circulation aneurysms >10 mm and are in common use at institutions in this country and across the world. Patients will be enrolled who meet the inclusion criteria and consent to participate. Patients will be randomly assigned by a central web-based system in a 1:1 manner to treatment with either endovascular coiling or flow diversion. Data on each patient will be collected at the time of enrollment and treatment, and at subsequent follow-up visits.

Enrollment

23 patients

Sex

All

Ages

21 to 75 years old

Volunteers

No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion criteria

Age 21 to 75 years, inclusive
Patient has a single target IA that: is located in the following regions of the internal carotid artery:
1. Paraophthalmic (including paraclinoid, ophthalmic and hypophyseal segments)
2. Cavernous
3. Petrous
has a parent vessel with diameter 2.5-5.0 mm
Wide neck aneurysm ≥4 mm.
Target IA has size (maximum fundus diameter) 10 mm
The operator feels that the aneurysm can be appropriately treated with traditional endovascular techniques (endovascular coil embolization with or without adjunctive devices or parent artery deconstruction) using endovascular coiling or flow diversion devices.
Modified Rankin Scale 0-3
Signed and dated informed consent

4.2 Exclusion criteria

More than one IA requiring treatment in the next 6 months
Subarachnoid hemorrhage in the past 60 days
Any intracranial hemorrhage in the last 42 days
Major surgery (requiring general anesthesia) in the last 42 days
Coils in place in the target IA
Unstable neurologic deficit (i.e., any rapidly worsening clinical condition in the last 30 days (defined by a change in mRS of 2 or more))
Known irreversible bleeding disorder
Platelet count < 100 x 103 cells/mm3 or known platelet dysfunction
Clinically documented evidence in medical history of adverse reaction or contraindication to medications used in treatment of the aneurysm (i.e. Plavix, heparin, aspirin)
Prior stent placement at target site
Documented history of dementia
Contraindication to CT scan and MRI (ie. contrast allergy, or other condition that prohibits imaging from either CT or MRI)
Known allergy to contrast used in angiography that cannot be medically controlled
Known severe allergy to platinum or cobalt/chromium alloys
Relative contraindication to angiography (e.g., serum creatinine > 2.5 mg/dL)
Pregnancy, breast-feeding, or positive pregnancy test [either serum or urine] (Woman of child-bearing potential must have a negative pregnancy test prior to the study procedure.)
Evidence of active infection (indicated by fever [at or over 99.9 °F] and/or open draining wound) at the time of randomization
Other known conditions of the heart, blood, brain or intracranial vessels that carry a high risk of neurologic events (e.g., severe heart failure, atrial fibrillation, known carotid stenosis)
Current use of cocaine or other illicit substance
Any comorbid disease or condition expected to compromise survival or ability to complete Follow-up assessments through 180 days
Extracranial stenosis greater than 50% in the carotid artery
Intracranial stenosis greater than 50% in the treated vessel
Based on investigator's judgment, patient does not have the necessary mental capacity to participate or is unwilling or unable to comply with protocol follow up appointment schedule.
"Previously randomized into this trial or currently participating in another trial where the data is intended to be used to obtain marketing approval or to broaden an indication, without the approval of the study principal investigator, that may confound the results of this study.

A screen failure log of all cases referred or presented for possible inclusion, but who were not randomized, and the reason(s) for exclusion will be maintained.