A Multicenter, Retrospective, Matched, Comparison Study of Clinical Efficacy and Cost-Effectiveness of Caterpillar Arterial Embolization Device versus Fibered Coils in Arterial Embolization
Round 1
Reviewer 1 Report
The authors have carried out a multi-centered, retrospective, matched, comparison study for testing the clinical efficacy as well as cost-effectiveness of Caterpillar Arterial Embolization Device vs. fibered coils in arterial embolization. It was found that the Caterpillar embolic device appears to be safe and effective in arterial occlusion. The Caterpillar device resulted in decreased time to vessel occlusion, decreased fluoroscopy and procedural time, and decreased costs. It was accordingly concluded that the Caterpillar device is an appealing choice for arterial embolization. This is an interesting study. Appropriate methodology has been employed and the conclusions appear to be justified based on the data at hand. The authors have described some of the limitations of their study. I only have some minor recommendations for consideration.
- Can the authors provide a clear hypothesis to be tested in the study.
- Methods/Results. While sex differences are not anticipated in the outcomes of the study, but since about 20-30% of the patients are female, the question is being asked.
- Are there similar studies performed in other jurisdictions? Whatever, the case, the authors should still emphasize and elaborate on the novelty aspect of their work.
Author Response
Reviewer 1 comments:
We thank reviewer 1 for their very insightful comments and analysis of our manuscript.
The authors have carried out a multi-centered, retrospective, matched, comparison study for testing the clinical efficacy as well as cost-effectiveness of Caterpillar Arterial Embolization Device vs. fibered coils in arterial embolization. It was found that the Caterpillar embolic device appears to be safe and effective in arterial occlusion. The Caterpillar device resulted in decreased time to vessel occlusion, decreased fluoroscopy and procedural time, and decreased costs. It was accordingly concluded that the Caterpillar device is an appealing choice for arterial embolization. This is an interesting study. Appropriate methodology has been employed and the conclusions appear to be justified based on the data at hand. The authors have described some of the limitations of their study. I only have some minor recommendations for consideration.
- Can the authors provide a clear hypothesis to be tested in the study.
The primary hypothesis of this study is that the Caterpillar Arterial Embolization Device can occlude the target arteries faster than coils. This has been added to the Introduction section.
- Methods/Results. While sex differences are not anticipated in the outcomes of the study, but since about 20-30% of the patients are female, the question is being asked.
When the RTO, Radiation Time, and procedure time were compared and analyzed between the female and male patients, no significant differences were noted.
- Are there similar studies performed in other jurisdictions? Whatever, the case, the authors should still emphasize and elaborate on the novelty aspect of their work.
This is the first report of comparing vascular plug or Caterpillar to conventional coils. This has been added to the Discussion section
Reviewer 2 Report
The appropriate selection of the embolic agent can be a significant confounder affecting success of the endovascular approach. In this retrospective, matched study clinical efficacy and of the implementation of the Caterpillar device in various arterial embolization procedures were analyzed in comparison with fibered coil deployments.
There were 48 pts enrolled, out of which in 16 cases Caterpillar devices were deployed. The latter cases were matched for embolized vessel type, size, and patients’ age but not for patient comorbidities/procedure indications. Can you comment on that?
Where there any antiplateletes/anticoagulants used preoperatively? Where there any follow-up of the cases?
Most importantly, RTO was dramatically different, along with radiation time. That affected cost as well. These were the pillars of the paper, while nearly all limitations were mentioned in the respective section.
Please format lines 78-88 in the introduction, and use subparagraphing in the material and methods.
Author Response
Reviewer 2 comments:
We thank reviewer 2 for their very insightful comments and analysis of our manuscript.
The appropriate selection of the embolic agent can be a significant confounder affecting success of the endovascular approach. In this retrospective, matched study clinical efficacy and of the implementation of the Caterpillar device in various arterial embolization procedures were analyzed in comparison with fibered coil deployments.
There were 48 pts enrolled, out of which in 16 cases Caterpillar devices were deployed. The latter cases were matched for embolized vessel type, size, and patients’ age but not for patient comorbidities/procedure indications. Can you comment on that?
In Table 1, these cases were also closely matched for the procedures indicated.
Where there any antiplateletes/anticoagulants used preoperatively? Where there any follow-up of the cases?
Due to bleeding risks, anti-platelets/anti-coagulation therapies were all held prior to the procedures based on the Society of Interventional Radiology Guideline.
As the primary purpose of this study was to see the immediate and peri-procedural outcomes of these embolic devices. Therefore, the follow up was not performed. However, it is absolutely important data to consider and will be considered for the future study.
Most importantly, RTO was dramatically different, along with radiation time. That affected cost as well. These were the pillars of the paper, while nearly all limitations were mentioned in the respective section.
Strongly agree with the reviewer’s comments.
Please format lines 78-88 in the introduction, and use subparagraphing in the material and methods.
Edited as suggested.
