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RT Journal Article
SR Electronic
T1 Endovascular Coiling versus Surgical Clipping for Poor-Grade Ruptured Intracranial Aneurysms: Postoperative Complications and Clinical Outcome in a Multicenter Poor-Grade Aneurysm Study
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 873
OP 878
DO 10.3174/ajnr.A4649
VO 37
IS 5
A1 Zhao, B.
A1 Tan, X.
A1 Yang, H.
A1 Li, Z.
A1 Zheng, K.
A1 Xiong, Y.
A1 Zhong, M.
YR 2016
UL http://www.ajnr.org/content/37/5/873.abstract
AB BACKGROUND AND PURPOSE: Endovascular coiling is an alternative to surgical clipping for ruptured intracranial aneurysms. However, no large multicenter prospective study has compared coiling and clipping in patients with poor-grade ruptured aneurysms. We aimed to determine differences in postoperative complications and clinical outcome between the 2 treatments in this group of patients.MATERIALS AND METHODS: A Multicenter Poor-Grade Aneurysm Study was a prospective, multicenter, observational registry of consecutive patients who presented with poor-grade ruptured aneurysms. Three hundred sixty-six patients were enrolled from October 2010 to March 2012. “Poor-grade aneurysm” was defined as a World Federation of Neurosurgical Societies grade of IV or V at the time of aneurysm treatment. Two hundred sixty-two patients received aneurysm treatment within 21 days and were included. Clinical outcomes were assessed at discharge and at 6 and 12 months by the modified Rankin Scale.RESULTS: One hundred thirty-three (50.8%) patients underwent endovascular coiling. Unadjusted analysis showed that the outcome rate (mRS 0–1 or mRS 0–2) at 6 and 12 months in patients undergoing coiling was higher than that in patients undergoing clipping. In adjusted analyses, there was no statistically significant difference in outcomes at 6 and 12 months between the 2 groups. The risk of radiologic hydrocephalus was higher in patients treated with coiling than that in those treated with clipping (adjusted OR, 3.36; 95% CI, 1.13–10.01; P = .030).CONCLUSIONS: The long-term outcome in selected patients was similar between endovascular coiling and clipping for poor-grade ruptured aneurysms. The risk of radiologic hydrocephalus was higher after endovascular treatment of poor-grade aneurysms.AMPASA Multicenter Poor-Grade Aneurysm StudyaSAHaneurysmal subarachnoid hemorrhageEVDexternal ventricular drainageGCSGlasgow Coma ScaleWFNSWorld Federation of Neurosurgical SocietiesISATInternational Subarachnoid Aneurysm Trial