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Trends and Outcomes of Endovascular Embolization and Surgical Clipping for Ruptured Intracranial Aneurysms: A Propensity-Matched Study of 1332 Patients in the United States. | LitMetric

AI Article Synopsis

  • The study aimed to compare the effectiveness and outcomes of two treatments—endovascular coil embolization and microsurgical clipping— for ruptured intracranial aneurysms in a cohort of over 1,300 patients.
  • Findings showed that while there was no significant difference in 1-year mortality rates between the two treatment methods, patients who underwent coiling experienced fewer complications, shorter intensive care stays, and less vasospasm compared to those who had clipping.
  • Specifically, patients with anterior communicating artery aneurysms treated with coiling had much lower rates of surgical complications and hydrocephalus, highlighting coiling as the more favorable option for this type of aneurysm.

Article Abstract

Objective: To describe recent trends in treatment and outcomes of endovascular coil embolization and microsurgical clipping treatment strategies for ruptured intracranial aneurysms.

Methods: Using International Classification of Diseases, Tenth Revision, codes, 1332 propensity-matched patients >18 years old who underwent coiling or clipping were identified. Patient demographics, baseline characteristics, comorbidities, and clinical outcomes were evaluated within 1 year postoperatively. Pooled and individual studies of the International Classification of Diseases codes investigated differences in clinical outcomes owing to aneurysm location. Outcomes were mortality, intensive care, surgical complications, hydrocephalus, and vasospasm.

Results: After propensity matching for baseline characteristics and comorbidities, 666 patients were included in the coiling and clipping cohorts. There was no significant difference in 1-year mortality between cohorts. However, incidence of intensive care, surgical/medical complications, and vasospasm was significantly lower in the pooled coiling cohort (P = 0.02, P = 0.03, and P = 0.014) compared with the clipping cohort within 1 year postoperatively. Additionally, individual International Classification of Diseases code analysis revealed that coiling of anterior communicating artery aneurysms was associated with significantly fewer surgical/medical complications and hydrocephalus (P = 0.0008 and P = 0.015) and coiling of posterior communicating artery aneurysms was associated with substantially less vasospasm treatment (P = 0.034) compared with the respective clipping cohorts.

Conclusions: Analysis revealed no difference in 1-year mortality between coiling and clipping. Clinical outcomes, including intensive care, surgical complications, and vasospasm, favored coiling regardless of aneurysm location. Patients with coiling of anterior communicating artery aneurysms had significantly less hydrocephalus and patients with coiling of posterior communicating artery aneurysms had substantially less vasospasm treatment within 1 year compared with the clipping cohort.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9081193PMC
http://dx.doi.org/10.1016/j.wneu.2022.02.077DOI Listing

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