Endovascular embolization vs surgical clipping in treatment of cerebral aneurysms: morbidity and mortality with short-term outcome

Clinical and Angiographic Follow-up of Ruptured Intracranial Aneurysms Treated with Endovascular Embolization

“…The International Subarachnoid Hemorrhage Trial (ISAT) demonstrated better outcomes for ruptured aneurysms treated with coiling vs clipping, with an absolute risk reduction of 7.4% and a 7-year survival advantage, 1 a finding supported by other studies. 2,3 However, a high percentage of aneurysmal remnants, unknown long-term stability, and potential rehemorrhage are current concerns with this technique. Incomplete treatment has been reported in 15% to 65%, and recanalization can occur in 14% to 34% of aneurysms treated, with rebleeding rates from 1.2 to 2.6%.…”

“…Our permanent morbidity and mortality rates were lower than other single-center studies on ruptured aneurysms. 3,18,[30][31][32][33] This may reflect our conservative strategy regarding the immediate angiographic result. The most common procedural complication was intraprocedural rupture (6.1%).…”

Bilateral paramedian thalamic and mesencephalic infarcts after basilar tip aneurysm coiling: role of the artery of Percheron

“…Risk of thromboembolism is 8.4 to 17.6% in previous reports 6,15 . Coiling has come to be regarded as safe and effective procedure for the treatment of basilar tip aneurysm 7 .…”

Computerized Angiographic Occlusion Rating for Ruptured Clipped Aneurysms is Superior to Subjective Occlusion Rating

“…Comparing the high number of "misclippings" (21% with SOR) with literature data, one can find that of 5 publications dealing with angiographic clipping rates, 5 describe patients having both ruptured and unruptured aneurysms; there, the rates of misclipping are 4.4%-18.6%. [15][16][17][18] The only report analyzing only patients clipped after subarachnoid hemorrhage as in the current study is the one by Yu et al, 19 who, in 2007, described a series of 169 patients with ruptured aneurysms. The authors disclosed a misclipping rate of 16%, but there was no comparable information about preoperative clinical grading in this study, because "patients in poor conditions warranted greater delay."…”