Short-Term Outcome of Clipping Versus Coiling of Ruptured Intracranial Aneurysms Treated by Dual-Trained Cerebrovascular Surgeon: Single-Institution Experience

Mario Zanaty; Nohra Chalouhi; Robert M Starke; Badih Daou; Michael Todd; Emine Bayman; James Torner; David Hasan

doi:10.1016/j.wneu.2016.08.009

Short-Term Outcome of Clipping Versus Coiling of Ruptured Intracranial Aneurysms Treated by Dual-Trained Cerebrovascular Surgeon: Single-Institution Experience

World Neurosurg. 2016 Nov:95:262-269. doi: 10.1016/j.wneu.2016.08.009. Epub 2016 Aug 13.

Authors

Mario Zanaty¹, Nohra Chalouhi², Robert M Starke³, Badih Daou², Michael Todd⁴, Emine Bayman⁴, James Torner⁵, David Hasan⁶

Affiliations

¹ Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA.
² Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
³ Department of Neurosurgery and Radiology, University of Miami, Miami, Florida, USA.
⁴ Department of Anesthesiology, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA.
⁵ Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA.
⁶ Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA. Electronic address: david-hasan@uiowa.edu.

PMID: 27535631
DOI: 10.1016/j.wneu.2016.08.009

Abstract

Objective: Studies that showed endovascular coiling of ruptured intracranial aneurysms (RAs) to be superior to microsurgical clipping have compared dedicated endovascular interventionists versus open cerebrovascular surgeons. This is the first study to evaluate outcomes of coiling versus clipping of RAs treated by a dual-trained cerebrovascular surgeon using a specific intervention protocol.

Methods: The prospectively maintained database was reviewed for all patients with RAs undergoing endovascular coiling (± stenting) or clipping by the senior author (dual-trained vascular neurosurgeon) between July 2010 and April 2015.

Results: Of the 252 patients identified, 70 underwent clipping and 182 underwent endovascular treatment. The mean and median time to last follow-up were 179.6 and 176.5 days in the endovascular cohort and 203.9 and 154.0 days in the surgical cohort. There was no difference in age, gender, World Federation of Neurosurgical Societies grade and Fisher grade, mean aneurysm size, and length of stay in the hospital/intensive care unit. Clipping had a higher proportion of middle cerebral artery aneurysms (37.1% vs. 8.8%; P < 0.001) and a lower proportion of aneurysms in the remaining locations (P < 0.001). 34.5% of the endovascular cohort and 32.9% of the clipping cohort were discharged home. There was no difference in modified Rankin Scale score at first or latest follow-up. Most had no significant disability. Mortality of endovascular treatment was 13.2% compared with 10.0% in clipping, and 16.5% versus 18.6% at the latest follow-up (both nonsignificant). The rate of conversion from coiling to clipping was 25.0%.

Conclusions: RA treatment should be individualized, with clipping and coiling being 2 complementary arms. Assessment of patient and aneurysm characteristics along with the advantages of both techniques provides an optimal therapeutic modality.

Keywords: Clipping; Coiling; Endovascular; Management; Ruptured cerebral aneurysm; Subarachnoid hemorrhage.

Publication types

Comparative Study

MeSH terms

Adult
Aged
Aged, 80 and over
Aneurysm, Ruptured / diagnosis
Aneurysm, Ruptured / surgery*
Cerebral Revascularization / methods
Cerebral Revascularization / standards
Databases, Factual
Endovascular Procedures / methods
Endovascular Procedures / standards*
Female
Humans
Intracranial Aneurysm / diagnosis
Intracranial Aneurysm / surgery*
Male
Middle Aged
Neurosurgical Procedures / methods
Neurosurgical Procedures / standards*
Prospective Studies
Surgeons / standards*
Surgical Instruments / standards*
Time Factors
Treatment Outcome
Young Adult