Published online before print April 20, 2006, doi: 10.1161/01.STR.0000221157.48691.8f
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(Stroke. 2006;37:1352.)
© 2006 American Heart Association, Inc.
Editorials |
Microsurgical Clipping or Endovascular Coiling for Ruptured Cerebral Aneurysms
From the Division of Neurosurgery, The University of British Columbia, Vancouver, BC.
Correspondence to Gary J. Redekop, Division of Neurosurgery, The University of British Columbia, 3100-910 W 10th Ave, Vancouver, BC, V5Z 4E5. E-mail gredekop@interchange.ubc.ca
Key Words: coil embolization • intracranial aneurysm • subarachnoid hemorrhage • surgical clipping
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
See related article, pages 1437–1442
Early aneurysm repair to prevent recurrent bleeding is central to the management of patients with subarachnoid hemorrhage. Over the past 15 years, endovascular occlusion of cerebral aneurysms has emerged as an alternative to microsurgical clipping, and the relative merits and shortcomings of these 2 approaches have been the subject of considerable discussion in the neurosurgical literature and at scientific meetings. The minimally invasive nature of endovascular treatment is inherently appealing, but in spite of technical improvements and adjuncts, such as balloons, stents, and biologically modified coils, complete and durable repair, especially in the case of large aneurysms and those with complex geometry or wide necks, remains a challenge.
The International Subarachnoid Aneurysm Trial (ISAT) compared microsurgical clipping and endovascular coil occlusion in patients with ruptured aneurysms felt to be suitable for either technique.1,2 Endovascular coiling resulted in a 23.9% relative risk reduction for death or dependency at 1 year, an absolute reduction of 7.4%. However, the study group represented only 22% of patients treated for subarachnoid hemorrhage at the participating institutions, and the results of the trial should not be generalized to patients with ruptured aneurysms clearly better suited for either clipping or coiling. The ISAT data showed that the risk of late rebleeding was low but more common after endovascular coiling than after clipping, and there are concerns about the long-term durability of coil occlusion, as well as the need for follow-up imaging and further treatment if aneurysm recurrence is detected.
The Cerebral
Related Article:
Stroke 2006 37: 1437-1442.