How Many Coils Do Patients With Aneurysmal Subarachnoid Hemorrhage Need?
To the Editor:
Congratulations for the very relevant work from Bederson et al1 addressing the evidence-based management of aneurysmal subarachnoid hemorrhage. However, the authors did not provide data on the average number of needed coils for each procedure. This issue is extremely important for many public health systems around the world that guarantee free distribution of high-cost treatments for their population. Therefore, we believe that such information, which is unavailable in many important trials analyzing coil embolization for aneurysmal subarachnoid hemorrhage,2–4 should be taken into account in future neurosurgical guidelines.
Bederson JB, Connolly ES Jr, Batjer HH, Dacey RG, Dion JE, Diringer MN, Duldner JE Jr, Harbaugh RE, Patel AB, Rosenwasser RH; American Heart Association. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 2009; 40: 994–1025.
Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R. International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet. 2002; 360: 1267–1274.
Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P. International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005; 366: 809–817.