Endovascular Coiling versus Surgical Clipping for Poor-Grade Ruptured Intracranial Aneurysms: Postoperative Complications and Clinical Outcome in a Multicenter Poor-Grade Aneurysm Study

Abstract

BACKGROUND AND PURPOSE: Endovascular coiling is an alternative to surgical clipping for ruptured intracranial aneurysms. However, no large multicenter prospective study has compared coiling and clipping in patients with poor-grade ruptured aneurysms. We aimed to determine differences in postoperative complications and clinical outcome between the 2 treatments in this group of patients.

Strategy for poor grade aneurysmal subarachnoid haemorrhage

“…Although endovascular coiling is more commonly used than clipping for ruptured aneurysms, there were no significant differences in outcome between coiling and clipping [2,3]. Our research concerning the treatment of poor clinical condition after aSAH is similar to this viewpoint [4].…”

Stent-assisted coiling versus coiling alone of poor-grade ruptured intracranial aneurysms: a multicenter study

“…This study protocol was approved by the Chinese Ethics Committee of Registering Clinical Trials. Details of the registry have been published elsewhere 14 15. Poor-grade aneurysms were defined as a World Federation of Neurosurgical Societies (WFNS) grade of IV or V after subarachnoid hemorrhage.…”

Poor-Grade Aneurysmal Subarachnoid Hemorrhage: Diagnosis, Therapeutical Management, and Prognosis

“…Mocco et al [31] reported that 35 (35.7%) of 98 patients received coiling, and there was also similar outcome between coiling and clipping for poor-grade aSAH. In our prospective and multicenter registry of 262 patients with poor-grade ruptured aneurysm, 133 (50.8%) patients received endovascular coiling within 21 days after poor-grade aSAH [53]. An unadjusted analysis showed that the rate of outcome (mRS 0-2 or mRS 0-3) at discharge at 6 and 12 months in the coiled patients was higher than that in the clipped patients probably because of selection bias.…”

“…Although endovascular treatment has been used as an available alternative to surgery for aSAH, surgical treatment is still an important treatment modality for poor-grade aSAH. In the contemporary multicenter cohorts of poor-grade aSAH, patients receiving clipping more often had a lower GCS score, a WFNS grade of V, a higher Fisher grade and modified Fisher grade, and a ruptured anterior circulation aneurysm than those receiving coiling [53]. Patients with WFNS grade V after emergency resuscitation, a better Fisher grade, brain herniation, the presence of ICH, or the absence of IVH more often underwent early surgical clipping [43].…”

“…There are no significant differences in rebleeding, cerebral infarction, symptomatic vasospasm, seizure, pneumonia between coiling and clipping groups. There is also no significant difference in outcomes at 6 and 12 months between the two treatments [53]. Decompressive craniectomy has been reported in the treatment for severe traumatic brain injury, massive ischemic stroke, and aSAH [54][55][56][57][58][59][60].…”