{"id":{"repo_id":"freiburg-diss","oai_identifier":"oai:freidok.uni-freiburg.de:1257"},"canonical_url":"https://search.dev.ndltd.org/etd/freiburg-diss/oai:freidok.uni-freiburg.de:1257","repository":{"repo_id":"freiburg-diss","name":"University of Freiburg","base_url":"https://freidok.uni-freiburg.de/oai/oai2.php"},"display":{"title":"Coiling and clipping in Aneurysmal Subarachnoid Hemorrhage","abstract":"Objective: This retrospective study was conducted to compare the primary aneurysm occlusion rate, procedure-related complications, morbidity, and mortality, and the clinical outcomes of endovascular coiling and neurosurgical clipping treatments in patients with aneurysmal SAH. <br>Material and Methods: This retrospective study analysed 322 patients with aneurysmal SAH which were treated between 1992 and 2003 at the University Hospital Freiburg. Patients were classified according to the Hunt and Hess grading system. There were 66 Grade I patients (20.5%), 103 Grade II (32.0%), 80 Grade III (24.8%), 54 Grade IV (16.8%) and 19 Grade V (5.9%). 167 patients were treated initially by endovascular coiling embolization, and 155 received clipping treatment. The percentage of aneurysm occlusions was divided into 100% or total occlusion, 95%–99% or subtotal occlusion, and less than 95% or incomplete occlusion. Clinical condition before treatment was measured by both WFNS score and Hunt and Hess grade. Clinical outcome at discharge was assessed by mRS. <br>Results: For ruptured aneurysms in coiling and clipping treatments, total occlusion rates were achieved in 67.5% and 88.9%, subtotal in 11.5% and 0.7%, incomplete in 13.4% and 9.8% respectively at the first session. The procedure related morbidity rate was 7.8% in neurosurgical treatment compared with 2.9% in endovascular group (p < 0.05). In-hospital mortality rates were 12.3% in the endovascular coiling treatment and 6.0% in the neurosurgical group. This correlated with the tendency of a higher rate of patients in a poorer H&H grade, Fisher grade, and WFNS score without statistical significant difference between treatment modalities. Crossover from coiling to clipping was more common (11 of 167 patients) than crossover from clipping to coiling therapy (1 of 155 patients). There was no significant difference in clinical outcome between two treatment groups and any subgroups. <br>Conclusions: In selected patients with a recently ruptured intracranial aneurysm, endovascular coiling is as effective as neurosurgical clipping in preventing rebleeding and in clinical outcomes at discharge.","abstract_html":"Objective: This retrospective study was conducted to compare the primary aneurysm occlusion rate, procedure-related complications, morbidity, and mortality, and the clinical outcomes of endovascular coiling and neurosurgical clipping treatments in patients with aneurysmal SAH. &lt;br&gt;Material and Methods: This retrospective study analysed 322 patients with aneurysmal SAH which were treated between 1992 and 2003 at the University Hospital Freiburg. Patients were classified according to the Hunt and Hess grading system. There were 66 Grade I patients (20.5%), 103 Grade II (32.0%), 80 Grade III (24.8%), 54 Grade IV (16.8%) and 19 Grade V (5.9%). 167 patients were treated initially by endovascular coiling embolization, and 155 received clipping treatment. The percentage of aneurysm occlusions was divided into 100% or total occlusion, 95%–99% or subtotal occlusion, and less than 95% or incomplete occlusion. Clinical condition before treatment was measured by both WFNS score and Hunt and Hess grade. Clinical outcome at discharge was assessed by mRS. &lt;br&gt;Results: For ruptured aneurysms in coiling and clipping treatments, total occlusion rates were achieved in 67.5% and 88.9%, subtotal in 11.5% and 0.7%, incomplete in 13.4% and 9.8% respectively at the first session. The procedure related morbidity rate was 7.8% in neurosurgical treatment compared with 2.9% in endovascular group (p &lt; 0.05). In-hospital mortality rates were 12.3% in the endovascular coiling treatment and 6.0% in the neurosurgical group. This correlated with the tendency of a higher rate of patients in a poorer H&amp;H grade, Fisher grade, and WFNS score without statistical significant difference between treatment modalities. Crossover from coiling to clipping was more common (11 of 167 patients) than crossover from clipping to coiling therapy (1 of 155 patients). There was no significant difference in clinical outcome between two treatment groups and any subgroups. &lt;br&gt;Conclusions: In selected patients with a recently ruptured intracranial aneurysm, endovascular coiling is as effective as neurosurgical clipping in preventing rebleeding and in clinical outcomes at discharge.","abstract_has_math":false,"creators":["Nie, Zhiyu"],"institution":null,"degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":["Schumacher, Martin"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":null,"date_issued":"","date_published":null,"updated_at":"2026-07-24T02:22:10Z","subjects":["coiling","clipping","Gefäßclipping","coling","subarachnoid hemorrhage"],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://freidok.uni-freiburg.de/data/1257","outbound_label":"Repository record","outbound_source":"source_url"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Schumacher, Martin"]},{"key":"dc:creator","label":"Author","values":["Nie, Zhiyu"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:type","label":"Dc Type","values":["DoctoralThesis"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["coiling","clipping","Gefäßclipping","coling","subarachnoid hemorrhage"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Objective: This retrospective study was conducted to compare the primary aneurysm occlusion rate, procedure-related complications, morbidity, and mortality, and the clinical outcomes of endovascular coiling and neurosurgical clipping treatments in patients with aneurysmal SAH. <br>Material and Methods: This retrospective study analysed 322 patients with aneurysmal SAH which were treated between 1992 and 2003 at the University Hospital Freiburg. Patients were classified according to the Hunt and Hess grading system. There were 66 Grade I patients (20.5%), 103 Grade II (32.0%), 80 Grade III (24.8%), 54 Grade IV (16.8%) and 19 Grade V (5.9%). 167 patients were treated initially by endovascular coiling embolization, and 155 received clipping treatment. The percentage of aneurysm occlusions was divided into 100% or total occlusion, 95%–99% or subtotal occlusion, and less than 95% or incomplete occlusion. Clinical condition before treatment was measured by both WFNS score and Hunt and Hess grade. Clinical outcome at discharge was assessed by mRS. <br>Results: For ruptured aneurysms in coiling and clipping treatments, total occlusion rates were achieved in 67.5% and 88.9%, subtotal in 11.5% and 0.7%, incomplete in 13.4% and 9.8% respectively at the first session. The procedure related morbidity rate was 7.8% in neurosurgical treatment compared with 2.9% in endovascular group (p < 0.05). In-hospital mortality rates were 12.3% in the endovascular coiling treatment and 6.0% in the neurosurgical group. This correlated with the tendency of a higher rate of patients in a poorer H&H grade, Fisher grade, and WFNS score without statistical significant difference between treatment modalities. Crossover from coiling to clipping was more common (11 of 167 patients) than crossover from clipping to coiling therapy (1 of 155 patients). There was no significant difference in clinical outcome between two treatment groups and any subgroups. <br>Conclusions: In selected patients with a recently ruptured intracranial aneurysm, endovascular coiling is as effective as neurosurgical clipping in preventing rebleeding and in clinical outcomes at discharge.","Untersuchungsziel: Die vorliegende retrospektive Studie untersuchte die Ergebnisse von Patienten mit gebluteteten Aneurysmen, die entweder endovaskulär mit Coils oder operativ mit Clip behandelt wurden. Ziel der Untersuchung war, die primäre Aneurysma-Okklusionsrate, eingriffsbedingte Komplikationen, Morbidität und Mortalität, sowie das klinische Ergebnis dieser Therapiemodalitäten zu vergleichen. <br>Material und Methode: Es wurden 322 Patienten mit gebluteten Aneurysma analysiert, die im Zeitraum von 1992 bis 2003 an der Universitätsklinik Freiburg behandelt wurden. Entsprechend der Hunt & Hess Graduierung waren 66 Patienten Grad I (20,5%), 103 Grad II (32%), 80 Grad III (24,8%), 54 Grad IV (16,8%) und 19 Grad V (5.9%). 167 Patienten wurden primär endovaskulär und 155 primär operativ behandelt. Die Aneurysma-Okklusionsrate wurde am Ende des Eingriffs als komplett (100%), subtotal (95-99%) oder inkomplett (<95%) verschlossen beurteilt. Der klinische Zustand der Patienten wurde vor der Behandlung mittels Hunt & Hess sowie WFNS ermittelt, während bei Entlassung der mRS erhoben wurde. <br>Ergebnisse: Die Aneurysma-Okklusionsrate war nach der ersten Behandlung entsprechend der Therapiemodalität endovaskulär versus operativ komplett in 67,5% versus 88,9%, subtotal 11,5% versus 0,7% und inkomplett 13,4% versus 9,8%. Die eingriffsbedingte Morbidität war 2,9% in der endovaskulär und 7,8% in der neurochirugisch behandelten Patientengruppe (p< 0,05), während die Mortalität 12,3% und 6% betrug. Die Mortalität war tendenziell eng mit dem initial schlechten Hunt & Hess Grad, Fisher Graduierung und WFNS verbunden, wobei keine statistisch relevanten Unterschiede festzustellen war. Ein Wechsel von einer zu anderen Therapiemodalität trat häufiger von endovaskulär zu operativ (11 of 167 patients) als umgekehrt (1 of 155 patients) auf. Keine signifikanten Unterschiede zwischen beiden Therapiemodalitäten gab es bezüglich des Behandlungsergebnisses bei Entlassung. <br>Schlußfolgerung: In ausgewählten Patienten mit rupturierten Aneurysmen sind die endovaskuläre Embolisation mit Coils und die operative Versorgung mit Clip in Bezug auf die Reblutungsrate und das klinische Ergebnis bei Entlassung gleichwertig."]},{"key":"dc:format.medium","label":"Dc Format Medium","values":["unknown"]},{"key":"dc:title","label":"Title","values":["Coiling and clipping in Aneurysmal Subarachnoid Hemorrhage","Coiling und Clipping bei aneurysmatisch bedingter subarachnoidaler Blutung"]}]}],"canonical_facts":{"dc:contributor":["Schumacher, Martin"],"dc:creator":["Nie, Zhiyu"],"dc:description.abstract":["Objective: This retrospective study was conducted to compare the primary aneurysm occlusion rate, procedure-related complications, morbidity, and mortality, and the clinical outcomes of endovascular coiling and neurosurgical clipping treatments in patients with aneurysmal SAH. <br>Material and Methods: This retrospective study analysed 322 patients with aneurysmal SAH which were treated between 1992 and 2003 at the University Hospital Freiburg. Patients were classified according to the Hunt and Hess grading system. There were 66 Grade I patients (20.5%), 103 Grade II (32.0%), 80 Grade III (24.8%), 54 Grade IV (16.8%) and 19 Grade V (5.9%). 167 patients were treated initially by endovascular coiling embolization, and 155 received clipping treatment. The percentage of aneurysm occlusions was divided into 100% or total occlusion, 95%–99% or subtotal occlusion, and less than 95% or incomplete occlusion. Clinical condition before treatment was measured by both WFNS score and Hunt and Hess grade. Clinical outcome at discharge was assessed by mRS. <br>Results: For ruptured aneurysms in coiling and clipping treatments, total occlusion rates were achieved in 67.5% and 88.9%, subtotal in 11.5% and 0.7%, incomplete in 13.4% and 9.8% respectively at the first session. The procedure related morbidity rate was 7.8% in neurosurgical treatment compared with 2.9% in endovascular group (p < 0.05). In-hospital mortality rates were 12.3% in the endovascular coiling treatment and 6.0% in the neurosurgical group. This correlated with the tendency of a higher rate of patients in a poorer H&H grade, Fisher grade, and WFNS score without statistical significant difference between treatment modalities. Crossover from coiling to clipping was more common (11 of 167 patients) than crossover from clipping to coiling therapy (1 of 155 patients). There was no significant difference in clinical outcome between two treatment groups and any subgroups. <br>Conclusions: In selected patients with a recently ruptured intracranial aneurysm, endovascular coiling is as effective as neurosurgical clipping in preventing rebleeding and in clinical outcomes at discharge.","Untersuchungsziel: Die vorliegende retrospektive Studie untersuchte die Ergebnisse von Patienten mit gebluteteten Aneurysmen, die entweder endovaskulär mit Coils oder operativ mit Clip behandelt wurden. Ziel der Untersuchung war, die primäre Aneurysma-Okklusionsrate, eingriffsbedingte Komplikationen, Morbidität und Mortalität, sowie das klinische Ergebnis dieser Therapiemodalitäten zu vergleichen. <br>Material und Methode: Es wurden 322 Patienten mit gebluteten Aneurysma analysiert, die im Zeitraum von 1992 bis 2003 an der Universitätsklinik Freiburg behandelt wurden. Entsprechend der Hunt & Hess Graduierung waren 66 Patienten Grad I (20,5%), 103 Grad II (32%), 80 Grad III (24,8%), 54 Grad IV (16,8%) und 19 Grad V (5.9%). 167 Patienten wurden primär endovaskulär und 155 primär operativ behandelt. Die Aneurysma-Okklusionsrate wurde am Ende des Eingriffs als komplett (100%), subtotal (95-99%) oder inkomplett (<95%) verschlossen beurteilt. Der klinische Zustand der Patienten wurde vor der Behandlung mittels Hunt & Hess sowie WFNS ermittelt, während bei Entlassung der mRS erhoben wurde. <br>Ergebnisse: Die Aneurysma-Okklusionsrate war nach der ersten Behandlung entsprechend der Therapiemodalität endovaskulär versus operativ komplett in 67,5% versus 88,9%, subtotal 11,5% versus 0,7% und inkomplett 13,4% versus 9,8%. Die eingriffsbedingte Morbidität war 2,9% in der endovaskulär und 7,8% in der neurochirugisch behandelten Patientengruppe (p< 0,05), während die Mortalität 12,3% und 6% betrug. Die Mortalität war tendenziell eng mit dem initial schlechten Hunt & Hess Grad, Fisher Graduierung und WFNS verbunden, wobei keine statistisch relevanten Unterschiede festzustellen war. Ein Wechsel von einer zu anderen Therapiemodalität trat häufiger von endovaskulär zu operativ (11 of 167 patients) als umgekehrt (1 of 155 patients) auf. Keine signifikanten Unterschiede zwischen beiden Therapiemodalitäten gab es bezüglich des Behandlungsergebnisses bei Entlassung. <br>Schlußfolgerung: In ausgewählten Patienten mit rupturierten Aneurysmen sind die endovaskuläre Embolisation mit Coils und die operative Versorgung mit Clip in Bezug auf die Reblutungsrate und das klinische Ergebnis bei Entlassung gleichwertig."],"dc:format.medium":["unknown"],"dc:subject":["coiling","clipping","Gefäßclipping","coling","subarachnoid hemorrhage"],"dc:title":["Coiling and clipping in Aneurysmal Subarachnoid Hemorrhage","Coiling und Clipping bei aneurysmatisch bedingter subarachnoidaler Blutung"],"dc:type":["DoctoralThesis"]},"updated_at":"2026-07-24T02:22:10Z"}