Endovascular Treatment or Neurosurgical Clipping of Ruptured Intracranial Aneurysms

Abstract

Background and Purpose-The effects of aneurysm treatment modality (clipping or coiling) on the incidence of cerebral vasospasm and infarction after subarachnoid hemorrhage have not been clearly defined. We hypothesized that there may be a difference in angiographic and clinical vasospasm, cerebral infarction, and clinical outcome between patients undergoing clipping compared to coiling. Methods-A retrospective, exploratory analysis of 413 patients randomized into the CONSCIOUS-1 trial was conducted.Patients underwent baseline and follow-up catheter angiography and computed tomography, as well as clinical assessments. Radiology end points were adjudicated by central blinded review, and angiographic vasospasm was quantified by measurements of arterial diameters on catheter angiography. The effect of method of aneurysm treatment (clipping [nϭ199] or coiling [nϭ214]) on angiographic vasospasm, delayed ischemic neurological deficit, cerebral infarction, and clinical outcome was analyzed using univariate and multivariate logistic regression. Propensity matching was used to adjust for differences in baseline risk factors between clipped and coiled patients. Results-In all patients and the propensity-matched subset, aneurysm coiling was associated with a significantly reduced risk of angiographic vasospasm and delayed ischemic neurological deficit compared to clipping. Cerebral infarction and clinical outcome were not associated with clipping or coiling. Conclusions-In this exploratory analysis, aneurysm coiling was associated with less angiographic vasospasm and delayed ischemic neurological deficit than surgical clipping, whereas no effect on cerebral infarction or clinical outcome was observed. Whether this is attributable to differences in baseline risk factors between clipped and coiled patients or a true difference cannot be proven here. (Stroke. 2010;41:2519-2524.)

Feasibility and Efficacy of Endovascular Therapy for Ruptured Distal Anterior Cerebral Artery Aneurysms

“…4,12,15) The results in the present study were similar. Primary brain damage is the greatest determining factor of the clinical outcome of patients undergoing endovascular therapy.…”

“…4,19) Although the risk of symptomatic vasospasm and/or shunt-dependent hydrocephalus in the patients with H/H grades 1-3 was very low in the present series, the number of subjects is too small to evaluate the effect of endovascular therapy.…”

Current Status of Ruptured Cerebral Aneurysm Treatment in Regional Hospitals and Results of Coil Embolization

“…A study using the data from the Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1) showed that clipping more frequently induced cerebral vasospasm and DCI compared with coil embolization. 17) Another study reported that cerebral retraction or vascular manipulation on clipping ≥48 hours after onset deteriorated cerebral vasospasm that had been present, increasing the incidence of cerebral infarction. 18) Based on this, early surgery after onset has been recommended, but such physical manipulation may be related to delayed cerebral vasospasm or infarction even in patients undergoing surgery within 48 hours after onset.…”

Use of CT Angiography and Digital Subtraction Angiography in Patients with Ruptured Cerebral Aneurysm: Evaluation of a Large Multihospital Data Base

“…CT angiography and DSA in the days after clipping or coiling might be performed to evaluate the treatment result or to evaluate vasospasm. Vasospasm and delayed ischemic deficits occur less frequently in patients treated with coiling relative to those treated with clipping, 12 which might contribute to less DSA and CT angiography after the aneurysm is treated by coiling. This study has several limitations.…”