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Hyporheic zones are commonly regarded as resilient and enduring interfaces between groundwater and surface water in river corridors. In particular, bedform‐induced advective pumping hyporheic exchange (bedform‐induced exchange) is often perceived as a relatively persistent mechanism in natural river systems driving water, solutes, and energy exchanges between the channel and its surrounding streambed sediments. Numerous studies have been based on this presumption. To evaluate the persistence of hyporheic zones under varying hydrologic conditions, we use a multi‐physics framework to model advective pumping bedform‐induced hyporheic exchange in response to a series of seasonal‐ and event‐scale groundwater table fluctuation scenarios, which lead to episodic river‐aquifer disconnections and reconnections. Our results suggest that hyporheic exchange is not as ubiquitous as generally assumed. Instead, the bedform‐induced hyporheic exchange is restricted to a narrow range of conditions characterized by minor river‐groundwater head differences, is intermittent, and can be easily obliterated by minor losing groundwater conditions. These findings shed light on the fragility of bedform‐induced hyporheic exchange and have important implications for biogeochemical transformations along river corridors. Plain Language Summary: The hyporheic zone is a small veneer connecting surface water and groundwater systems, which supports vital ecosystem services along river corridors. The current paradigm assumes this exchange zone is ubiquitous and relatively stable over space and time. Yet, the dynamic nature of the surface and subsurface process driving and modulating the exchange can lead to complex spatiotemporal dynamics where bedform‐induced hyporheic zones are only present for short periods or are absent. In this study, we investigated how persistent hyporheic zones are under typical groundwater dynamics. We found that bedform‐induced hyporheic zones are not as stable as usually assumed, and their presence is restricted to a narrow range of hydrological conditions. The findings reveal the fragility of hyporheic zones and offer new perspectives to conceptualize river connectivity processes. Key Points: We explore bedform‐induced hyporheic exchange under various seasonal‐ and event‐scale groundwater table fluctuation scenariosBedform‐induced exchange is intermittent and limited to a narrow range of conditions where river‐groundwater head differences are smallBedform‐induced exchange fragility highlights the need for better representations of turbulence and turnover drivers in water quality models [ABSTRACT FROM AUTHOR]

Background and purposeComparing outcomes between endovascular aneurysm coiling trials can be difficult because of heterogeneity in patients and end points. We sought to understand the impact of geography on aneurysm retreatment in patients enrolled in the Matrix and Platinum Science Trial.Materials and methodsPost hoc analysis was performed on data from the Matrix and Platinum Science trial. Patients were stratified as either North American or international. Baseline patient demographics, comorbidities, aneurysm characteristics, procedural complications, and clinical and angiographic outcomes were compared.ResultsWe evaluated 407 patients from 28 North American sites and 219 patients from 15 international sites. Patient demographics differed significantly between North American and international sites. Aneurysms were well occluded postprocedure more often at international than North American sites (P < .001). Stents were used significantly more often at North American sites (32.7% [133 of 407]) compared with international sites (10.0% [22 of 219]; P < .001). At 455 days, there was no difference in the proportion of patients alive and free of disability (P = .56) or with residual aneurysm filling (P = .10). Ruptured aneurysms were significantly more likely to have been retreated at North American sites within the first year (P < .001) and at 2 years (P < .001). Among all patients for whom the treating physician believed there to be Raymond 3 aneurysm filling at follow-up, absolute rates of retreatment at international and North American sites were similar by 2-year follow-up.ConclusionsData from the Matrix and Platinum Science Trial demonstrate that aneurysm retreatment occurs with different frequency and at different times in different regions of the world. This trend has critical value when interpreting trials reporting short-term outcomes, especially when judgment-based metrics such as retreatment are primary end points that may or may not take place within the defined study follow-up period. Though these variations can be controlled for and balanced within a given randomized trial, such differences in practice patterns must be accounted for in any attempt to compare outcomes between different trials. Despite these differences, endovascular-treated intracranial aneurysms around the world have similar clinical outcomes.

Background and purposeThe ability of polymer-modified coils to promote stable aneurysm occlusion after endovascular treatment is not well-documented. Angiographic aneurysm recurrence is widely used as a surrogate for treatment failure, but studies documenting the correlation of angiographic recurrence with clinical failure are limited. This trial compares the effectiveness of Matrix(2) polyglycolic/polylactic acid biopolymer-modified coils with bare metal coils and correlates the angiographic findings with clinical failure (ie, target aneurysm recurrence), a composite end point that includes any incident of posttreatment aneurysm rupture, retreatment, or unexplained death.Materials and methodsThis was a multicenter randomized noninferiority trial with blinded end point adjudication. We enrolled 626 patients, divided between Matrix(2) and bare metal coil groups. The primary outcome was target aneurysm recurrence at 12 ± 3 months.ResultsAt 455 days, at least 1 target aneurysm recurrence event had occurred in 14.6% of patients treated with bare metal coils and 13.3% of Matrix(2) (P = .76, log-rank test) patients; 92.8% of target aneurysm recurrence events were re-interventions for aneurysms that had not bled after treatment, and 5.8% of target aneurysm recurrence events resulted from hemorrhage or rehemorrhage, with or without retreatment. Symptomatic re-intervention occurred in only 4 (0.6%) patients. At 455 days, 95.8% of patients with unruptured aneurysms and 90.4% of those with ruptured aneurysms were independent (mRS ≤ 2). Target aneurysm recurrence was associated with incomplete initial angiographic aneurysm obliteration, presentation with rupture, and a larger aneurysmal dome and neck size.ConclusionsTested Matrix(2) coils were not inferior to bare metal coils. Endovascular coiling of intracranial aneurysms was safe, and the rate of technical success was high. Target aneurysm recurrence is a promising clinical outcome measure that correlates well with established angiographic measurements.

Background and purposeStent-assisted coiling may result in less aneurysm recanalization but more complications than coiling alone. We evaluated outcomes of coiling with and without stents in the multicenter Matrix and Platinum Science Trial.Materials and methodsAll patients in the Matrix and Platinum Science Trial with unruptured intracranial aneurysms treated per protocol were included. Baseline patient and aneurysm characteristics, procedural details, neurologic outcomes, angiographic outcomes, and safety data were analyzed.ResultsOverall, 137 of 361 (38%) patients were treated with a stent. Stent-coiled aneurysms had wider necks (≥4 mm in 62% with stents versus 33% without, P < .0001) and lower dome-to-neck ratios (1.3 versus 1.8, P < .0001). Periprocedural serious adverse events occurred infrequently in those treated with and without stents (6.6% versus 4.5%, P = .39). At 1 year, total significant adverse events, mortality, and worsening of mRS were similar in treatment groups, but ischemic strokes were more common in stent-coiled patients than in coiled patients (8.8% versus 2.2%, P = .005). However, multivariate analysis confirmed that at 2 years after treatment, prior cerebrovascular accident (OR, 4.7; P = .0089) and aneurysm neck width ≥4 mm (OR, 4.5; P = .02) were the only independent predictors of ischemic stroke. Stent use was not an independent predictor of ischemic stroke at 2 years (OR, 1.1; P = .94). Stent use did not predict target aneurysm recurrence at 2 years, but aneurysm dome size ≥10 mm (OR, 9.94; P < .0001) did predict target aneurysm recurrence.ConclusionsStent-coiling had similar outcomes as coiling despite stented aneurysms having more difficult morphology than coiled aneurysms. Increased ischemic events in stent-coiled aneurysms were attributable to baseline risk factors and aneurysm morphology.