Coiling and clipping in Aneurysmal Subarachnoid Hemorrhage
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. 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. 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. 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.
coiling, clipping, Gefäßclipping, coling, subarachnoid hemorrhage
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