TARGET® Intracranial Aneurysm Coiling Prospective Multicenter Registry: Final Analysis of Peri-Procedural and Long-Term Safety and Efficacy Results

Osama O Zaidat, Alicia C Castonguay, Ansaar T Rai, Aamir Badruddin, William J Mack, Amer K Alshekhlee, Qaisar A Shah, Syed I Hussain, Mouhammed R Kabbani, Ketan R Bulsara, Asif M Taqi, Vallabh Janardhan, Mary S Patterson, Brittany L Nordhaus, Lucas Elijovich, Ajit S Puri, Osama O Zaidat, Alicia C Castonguay, Ansaar T Rai, Aamir Badruddin, William J Mack, Amer K Alshekhlee, Qaisar A Shah, Syed I Hussain, Mouhammed R Kabbani, Ketan R Bulsara, Asif M Taqi, Vallabh Janardhan, Mary S Patterson, Brittany L Nordhaus, Lucas Elijovich, Ajit S Puri

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.

Figures

Figure 1
Figure 1
Illustrative case example demonstrating the 100% 360 coiling case in a patient with subarachnoid hemorrhage.

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