Initial Technical Experience with the SMART Coil for the Embolization of Intracranial Aneurysms

Background/Objective Traditional platinum coils used for cerebral aneurysm embolization have a uniform degree of softness throughout an individual coil's length. Recently, SMART Coils (Penumbra Inc., Alameda, California, USA) have been developed, which transition in softness along the length of their coils. We report the initial clinical results with this technology. Methods A retrospective study of all patients undergoing aneurysm coiling with SMART Coils at 2 centers was performed to evaluate the safety and efficacy of this new technology. Outcome and angiographic data were self-reported by individual treatment centers. Results Fifty-nine patients underwent treatment for cerebral aneurysms with SMART Coils (44% in the setting of subarachnoid hemorrhage). Mean aneurysm size was 5.9 ± 2 mm × 4.5 ± 2 mm. Mean neck size was 3.4 ± 1 mm. More than half (54.2%) of the patients underwent coiling exclusively with SMART Coils. The remainder used either framing or finishing coils of another type. About one third (33.9%) underwent balloon-assisted coiling, and 47.5% underwent stent-assisted coiling. There were no device malfunctions in any of the patients. Six (10.1%) minor complications without clinical sequelae occurred. Raymond I or II occlusion was achieved in 71.2%. Conclusions Our results demonstrate adequate device safety in a variety of both ruptured and unruptured aneurysm locations. This design enables progressive changes in softness along the length of an individual coil, which offers several potential advantages in the clinical use. This initial investigation of SMART Coil technology demonstrates safety and efficacy in the treatment of a wide range of aneurysm sizes, locations, and morphologies in both ruptured and unruptured settings.