Published online before print April 20, 2006, doi: 10.1161/01.STR.0000221331.01830.ce
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Stroke. 2006;37:1437.)
© 2006 American Heart Association, Inc.
Original Contributions |
Rates of Delayed Rebleeding From Intracranial Aneurysms Are Low After Surgical and Endovascular Treatment
*For complete listing of investigators along with the affiliation list, please see the Appendix.
Correspondence to S. Claiborne Johnston, MD, PhD, Department of Neurology, Box 0114, University of California, San Francisco, 505 Parnassus Ave, M-798, San Francisco, CA 94143-0114. E-mail clay.johnston{at}ucsfmedctr.org
Background and Purpose— Although results of the randomized International Subarachnoid Aneurysm Trial suggested that coil embolization was superior to surgical clipping 1 year after treatment, a paucity of data on long-term outcomes has been a major concern.
Methods— In an ambidirectional cohort study, 9 institutions with expertise in intracranial aneurysm treatment identified all ruptured saccular aneurysms treated 1996 to 1998. After an initial medical record review, all patients meeting entry criteria were contacted by postal questionnaire or telephone. Possible reruptures were adjudicated independently by a neurologist, a neurosurgeon, and a neurointerventional radiologist. Rates of delayed (>1 year) and early rerupture and retreatment were evaluated using Kaplan-Meier survival analysis and the log-rank test.
Results— A total of 1010 patients (711 surgically clipped, 299 treated with coil embolization) were included. Patients treated with coil embolization were older, more likely to have smaller aneurysms arising from the posterior circulation, and less likely to have middle cerebral artery aneurysms. Rerupture of the index aneurysm after 1 year occurred in 1 patient treated with coil embolization during 904 person-years of follow-up (annual rate 0.11%) and in no patients treated with surgical clipping during 2666 person-years (P=0.11). Aneurysm retreatment after 1 year was more frequent in patients treated with coil embolization (P<0.0001), but major complications were rare during retreatment.
Conclusions— Rerupture of aneurysms treated by either coil embolization or surgical clipping is rare after the first year. Late retreatment is more common after coil embolization than after clipping but complication rates are low. Thus, late events are unlikely to overwhelm differences between procedures at 1-year follow-up.
Key Words: craniotomy • interventional radiography • intracranial aneurysm • subarachnoid hemorrhage
Related Article:
Stroke 2006 37: 1352-1353.
This article has been cited by other articles:
 |
|
 |
|
  C. O'Kelly and R. L. Macdonald Coiling and Aneurysm Rerupture: Incomplete Treatment Is a Causal Intermediate Not a Confounder Stroke, July 1, 2008; 39(7): e121 - e121. [Full Text] [PDF]
|
|
|
|
|
|
S. C. Johnston and for The Cerebral Aneurysm Rerupture After Treatmen Response to Letter by O'Kelly and Macdonald Stroke, July 1, 2008; 39(7): e122 - e122. [Full Text] [PDF]
|
|
|
|
|
|
L. Elijovich, R. T. Higashida, M. T. Lawton, G. Duckwiler, S. Giannotta, S. C. Johnston, and for The Cerebral Aneurysm Rerupture After Treatmen Predictors and Outcomes of Intraprocedural Rupture in Patients Treated for Ruptured Intracranial Aneurysms: The CARAT Study Stroke, May 1, 2008; 39(5): 1501 - 1506. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. G. Piepgras and R. D. Brown Jr Management of Unruptured Intracranial Aneurysms: Perspectives on Endosaccular Coiling and Persistent Uncertainties Stroke, March 1, 2008; 39(3): 743 - 744. [Full Text] [PDF]
|
|
|
|
|
|
S. C. Johnston, C. F. Dowd, R. T. Higashida, M. T. Lawton, G. R. Duckwiler, D. R. Gress, and for the CARAT Investigators Predictors of Rehemorrhage After Treatment of Ruptured Intracranial Aneurysms: The Cerebral Aneurysm Rerupture After Treatment (CARAT) Study Stroke, January 1, 2008; 39(1): 120 - 125. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Ries, S. Siemonsen, G. Thomalla, U. Grzyska, H. Zeumer, and J. Fiehler Long-Term Follow-Up of Cerebral Aneurysms after Endovascular Therapy Prediction and Outcome of Retreatment AJNR Am. J. Neuroradiol., October 1, 2007; 28(9): 1755 - 1761. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R.C. Wallace, J.P. Karis, S. Partovi, and D. Fiorella Noninvasive Imaging of Treated Cerebral Aneurysms, Part I: MR Angiographic Follow-Up of Coiled Aneurysms AJNR Am. J. Neuroradiol., June 1, 2007; 28(6): 1001 - 1008. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D.F. Kallmes and H.J. Cloft Ready or Not, Here They Come: Randomized Trials Evaluating New Endovascular Aneurysm Therapies AJNR Am. J. Neuroradiol., May 1, 2007; 28(5): 799 - 803. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Linfante and A. K. Wakhloo Brain Aneurysms and Arteriovenous Malformations: Advancements and Emerging Treatments in Endovascular Embolization Stroke, April 1, 2007; 38(4): 1411 - 1417. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Pelz, E. I. Levy, and L. N. Hopkins Advances in Interventional Neuroradiology 2006 Stroke, February 1, 2007; 38(2): 232 - 234. [Full Text] [PDF]
|
|
|
|
|
|
G. J. Redekop Microsurgical Clipping or Endovascular Coiling for Ruptured Cerebral Aneurysms Stroke, June 1, 2006; 37(6): 1352 - 1353. [Full Text] [PDF]
|
|