Stryker XL Coils Are Significantly Cheaper yet Equally Efficacious and Safe Compared to Non-xl Coils in Endovascular Treatment of Intracranial Aneurysms

Introduction: Intracranial aneurysms are treated using either an open surgical clipping or an endovascular coiling procedure. Treatment of aneurysms by endovascular coiling has shown improved morbidity and mortality compared to traditional open surgical clipping. Stryker Target XL 360 coils are on average 66% longer and occupy twice as much volume per coil as the traditional Stryker Target 360 coils. This would mean that less amount of coil is needed to embolize a given aneurysm using Stryker XL compared to non-XL coils. Although this can translate to potentially significant cost saving for patients, little data exists on how XL coils compare in safety, efficacy, and cost efficiency to non-XL coils.

Methods: We retrospectively reviewed the medical records of 43 patients who underwent endovascular coiling of an intracranial aneurysm using both XL and non-XL coils at the Dartmouth Hitchcock Medical Center between 2016-2021. Patient demographics, aneurysm morphology, coil type/quantity, and outcome data were recorded. The hospital billing system was separately queried for the cost data. For each patient the intraoperative digital subtraction angiopathy (DSA) image was used to calculate an aneurysm volume. The aneurysm volume and coils used were then inputted into the AngioSuite application to calculate the contribution of XL vs non-XL coils to the total packing density. We calculated a standardize cost-per-percent packing density contributed for each type of coil.

Results: The XL coils are on average 2.9 times cheaper than non-XL coils (p < 0.001). The average packing density was 35.5%. No coil-related complications were noted during the intra-op or immediately post-op period. Of the 43 cases reviewed 7 showed signs of coil compaction up to 3 years after the procedure.

Conclusion : We show that Stryker XL coils are significantly cheaper while equally efficacious and safe as the non-XL coils in treatment of intracranial aneurysms. This translates to significant cost saving for hospitals and patients. Additionally, since fewer XL coils are necessary to achieve a desired packing density, using XL coils can reduce the overall operation time and the associated complications.