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AJNR - American Journal of Neuroradiology

Published ahead of print on January 9, 2008
doi: 10.3174/ajnr.A0895

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American Journal of Neuroradiology 29:753-759, April 2008
© 2008 American Society of Neuroradiology

INTERVENTIONAL

Outcomes of Ruptured Intracranial Aneurysms Treated by Microsurgical Clipping and Endovascular Coiling in a High-Volume Center

S.K. Natarajan^a, L.N. Sekhar^a, B. Ghodke^b, G.W. Britz^a,b, D. Bhagawati^a and N. Temkin^a,c

^a Departments of Neurological Surgery, University of Washington, Seattle, Wash
^b Departments of Interventional Neuroradiology, University of Washington, Seattle, Wash
^c Departments of Biostatistics, University of Washington, Seattle, Wash

Please address correspondence to Laligam N Sekhar, MD, FACS, Department of Neurological Surgery, Harborview Medical Center, Box 359766, Seattle, WA 98104; e-mail: lsekhar{at}u.washington.edu

BACKGROUND AND PURPOSE: The purpose of this study was to analyze the 3-month outcomes of patients with aneurysmal subarachnoid hemorrhage (SAH) treated from January 2005 to June 2006. This paper describes the outcomes after treatment of aneurysmal SAH and comparison between patients treated by clipping or coiling in a high volume center.

MATERIALS AND METHODS: A retrospective chart review was performed of records of 195 consecutive patients with SAH. The overall outcome and the pretreatment variables predicting outcomes and the difference between the clipping and coiling groups were analyzed by logistic regression analysis.

RESULTS: A total of 105 (55%) patients had microsurgical clipping and 87 (45%) had endovascular coiling. At 3 months, 69% of patients recovered with no or mild disability. The predictors of a 3-month modified Rankin Scale (mRS) were Hunt and Hess (HH) grade on admission and the presence of intracerebral hemorrhage (ICH). Patients in the coiling group had worse admission grades; they had worse 3-month mRS (2.28 vs 1.73), but this was not significant when the groups were matched (P = .38). Vasospasm rate was significantly higher in the clipping group (66% vs 52%). The immediate incomplete occlusion rate of aneurysms was higher (21.7% vs 7.6%) in the coiling group.

CONCLUSION: The overall results of treatment of aneurysmal SAH have improved. There is no significant difference in the outcomes between the patients in the clipping and coiling groups.

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