The Hydrogel Endovascular Aneurysm Treatment Trial (HEAT): A Randomized Controlled Trial of the Second-Generation Hydrogel Coil
Authors: Bendok Bernard R , Abi-Aad Karl R , Ward Jennifer D , Kniss Jason F , Kwasny Mary J , Rahme Rudy J , Aoun Salah G , El Ahmadieh Tarek Y , El Tecle Najib E , Zammar Samer G , Aoun Rami James N , Patra Devi P , Ansari Sameer A , Raymond Jean , Woo Henry H , Fiorella David , Dabus Guilherme , Milot Genevieve , Delgado Almandoz Josser E , Scott John A , DeNardo Andrew J , Dashti Shervin R ,   HEAT Study Investigators, Ansari Sameer , Deshaies Eric , Lavine Sean , Bozorgchami Hormozd , Delgado Josser , Veznedaroglu Erol , Albuquerque Felipe , Fiorella David , Boulos Alan , Cortes Maria , Kanaan Hilal , Jindal Gaurav , Klucznik Richard , Dabus Guilherme , Kalmes David , Tawk Rabih , Raymond Jean , Romero Charles , Xavier Andrew , Hussain Muhammad , Kelly Michael , Moran Christopher , Chaudry Imran , Pandey Aditya , Wang Dennis , van Adel Brian , Milot Genevieve , Hirsch Joshua , Carpenter Jeffrey , Powers Ciaran , Jabbour Pascal , Luh George , Shankar Jai , Tummala Ramanchandra , Patsalides Athos , Evans Avery , Garg Ankur , Dashti Shervin , Lee Sung , James Roberts , Jayaraman Mahesh , Satti Sudhakar , Sauvageau Eric , Fields Jeremy , Grobelny Thomas , Hartman Johnathan 
Published: February 2020

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.

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