Outcome of Surgical Clipping of Unruptured Aneurysms as it Compares with a 10-Year Nonclipping Survival Period

Krisht, Ali F.; Gómez, Jorge; Partington, Sharon

doi:10.1227/01.neu.0000194638.61073.fc

Cited by 53 publications

(14 citation statements)

References 77 publications

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“…24 It has Our results showed that the pooled rates of morbidity as defined by mRS were 5% (95% CI  1-10%) and 8% (95% CI  3-14%) for coiling and clipping, respectively, which is consistent with previous studies where the rates of morbidity was reported to be 1% for endovascular coiling and 3% for surgical clipping. 29,30 These findings indicate that the two procedures bear similar risks of morbidity, which is further supported by our results that the pooled risk ratios of morbidity as defined by mRS was 0.53 (95% CI  0.18-1.52). Moreover, our results showed that the risk ratio of morbidity assessed through GOS was 0.67 (95% CI  0.18-2.45).…”

Section: Discussionsupporting

confidence: 81%

Endovascular coiling vs. surgical clipping for unruptured intracranial aneurysm: A meta-analysis

Ruan

Long

Sun

et al. 2015

British Journal of Neurosurgery

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We suggest that endovascular coiling and surgical clipping bear similar risk ratios of death, bleeding, cerebral ischemia, occlusion of aneurysm, and independence in daily activities and encourage further studies on quality of life and cognitive outcome. However, albeit the results in this meta-analysis are robust, due to great clinical heterogeneity and low quality of studies, the results in this meta-analysis should be interpreted with caution.

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Section: Discussionsupporting

confidence: 81%

Endovascular coiling vs. surgical clipping for unruptured intracranial aneurysm: A meta-analysis

Ruan

Long

Sun

et al. 2015

British Journal of Neurosurgery

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“…Park et al describe a direct endovascular mortality rate of 7.6% in ruptured aneurysms [25], while Zheng et al report a mortality rate of 0.85% [26]. A direct mortality rate of 0.8% was stated for the microsurgical clipping procedure in the treatment of non-ruptured aneurysms [27]. De Vries et al found a combined procedural persistent neurological morbidity and mortality after endovascular treatment and open surgical clipping of 2.1% and 1.4%, respectively [28].…”

Section: Discussionmentioning

confidence: 99%

Treatment of ruptured intracranial aneurysms yesterday and now

et al. 2017

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ObjectiveThis prospective study is designed to detect changes in the treatment of ruptured intracranial aneurysms over a period of 17 years.MethodsWe compared 361 treated cases of aneurysm occlusion after subarachnoid hemorrhage from 1997 to 2003 with 281 cases from 2006 to 2014. Specialists of neuroradiology and vascular neurosurgery decided over the modality assignment. We established a prospective data acquisition in both groups to detect significant differences within a follow-up time of one year. With this setting we evaluated the treatment methods over time and compared endovascular with microsurgical treatment.ResultsWhen compared to the earlier group, microsurgical treatment was less frequently chosen in the more recent collective because of neck-configuration. Endovascular treatment was chosen more frequently over time (31.9% versus 48.8%). Occurrence of initial symptomatic ischemic stroke was significantly lower in the clipping group compared to the endovascular group and remained stable over time. The number of reinterventions due to refilled treated aneurysms significantly decreased in the endovascular group at one-year follow-up, but the significantly better occlusion- and reintervention-rate of the microsurgical group persisted. The rebleeding rate in the endovascular group at one year follow-up decreased from 6.1% to 2.2% and showed no statistically significant difference to the microsurgical group, anymore (endovascular 2.2% versus microsurgical 0.0%, p = 0.11).ConclusionMicrosurgical clipping still has some advantages, however endovascular treatment is improving rapidly.

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“…This figure is significantly greater than the 4.2% combined morbidity and mortality rates that their patient population actually experienced, suggesting that surgical treatment may represent a superior approach to conservative management in patients with life expectancies greater than 10 years [31]. …”

Section: Treatment Options For Uiasmentioning

confidence: 99%

The Natural History and Treatment Options for Unruptured Intracranial Aneurysms

Loewenstein

Gayle

Duffis

et al. 2012

International Journal of Vascular Medicine

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Recent advances in angiographic technique have raised our awareness of the presence of unruptured intracranial aneurysms (UIAs). However, the appropriate management for these lesions remains controversial. To optimize patient outcomes, the physician must weigh aneurysmal rupture risk associated with observation against the complication risks associated with intervention. In the case that treatment is chosen, the two available options are surgical clipping and endovascular coiling. Our paper summarizes the current body of literature in regards to the natural history of UIAs, the evolution of the lesion if it progresses uninterrupted, as well as the safety and efficacy of both treatment options. The risks and benefits of treatment and conservative management need to be evaluated on an individual basis and are greatly effected by both patient-specific and aneurysm-specific factors, which are presented in this paper. Ultimately, this body of data has led to multiple sets of treatment guidelines, which we have summated and presented in this paper.

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Outcome of Surgical Clipping of Unruptured Aneurysms as it Compares with a 10-Year Nonclipping Survival Period

Cited by 53 publications

References 77 publications

Endovascular coiling vs. surgical clipping for unruptured intracranial aneurysm: A meta-analysis

Endovascular coiling vs. surgical clipping for unruptured intracranial aneurysm: A meta-analysis

Treatment of ruptured intracranial aneurysms yesterday and now

The Natural History and Treatment Options for Unruptured Intracranial Aneurysms

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