Abstract
BACKGROUND AND PURPOSE: ISAT provided valuable data on patient outcome after endovascular coiling and surgical clipping of ruptured aneurysms. The purpose of this study was to retrospectively review the ≥1-year outcome (in terms of survival, independence, and rebleeding) of patients who were treated in a routine clinical setting.
MATERIALS AND METHODS: Records of patients presenting with an SAH from a ruptured aneurysm between 2000 and 2008 were reviewed. The 403 patients who met the inclusion criteria harbored 443 treated aneurysms; 173 were managed surgically and 230 by endovascular means. Mean clinical follow-up was 33.9 months (range, 12–106 months).
RESULTS: The pretreatment clinical condition according to the HH was significantly better in the surgically treated patients (P = .018). Death occurred in 11.6% after surgery and in 17.4% after endovascular treatment (P = .104). Of the surviving patients in the surgical and endovascular groups, 80.3% and 87.2%, respectively, were able to live independently with grades 0–2 on the mRS (P = .084). Complete aneurysm occlusion was achieved significantly more often after surgical treatment (P < .001). Rebleeding occurred in 3.1% and 2.3% of the patients after surgical treatment and endovascular coiling, respectively. The occurrence of a residual aneurysm at the end of a coiling procedure was significantly related to the frequency of rebleeding (P = .007).
CONCLUSIONS: The management of patients with intracranial aneurysms in a routine clinical setting shows good and comparable rates of mortality and independence. Coiling results in lower rates of complete aneurysm occlusion. Postcoiling angiography showing a residual aneurysm is a good predictor of the risk of rebleeding.
Footnotes
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- ACA
- anterior cerebral artery
- ACA A1
- anterior cerebral artery proximal to the origin of the anterior communicating artery
- ACA A2
- anterior cerebral artery distal to the origin of the anterior communicating artery
- AcomA
- anterior communicating artery
- CTA
- CT angiography
- DSA
- digital subtraction angiography
- GDC
- Guglielmi detachable coil
- ICA
- internal carotid artery
- HH
- Hunt and Hess scale
- ISAT
- International Subarachnoid Aneurysm Trial
- MCA
- middle cerebral artery
- MCA M1
- middle cerebral artery proximal to the bifurcation
- MCA M2
- middle cerebral artery distal to the bifurcation
- MRA
- MR angiography
- mRS
- modified Rankin scale
- PCA
- posterior cerebral artery
- PcomA
- posterior communication artery
- PICA
- posterior inferior cerebellar artery
- SAH
- subarachnoid hemorrhage
- SCA
- superior cerebellar artery
- © 2011 American Society of Neuroradiology