scholarly journals C.03 Surgical clipping or endovascular coiling for unruptured intracranial aneurysms: a pragmatic randomized trial

2017 ◽  
Vol 44 (S2) ◽  
pp. S12-S13
Author(s):  
TE Darsaut ◽  
Keyword(s):  
Randomized Trial ◽  
Intracranial Aneurysms ◽  
Primary Outcome ◽  
Morbidity And Mortality ◽  
Neurological Deficits ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Microsurgical Clipping ◽  
Unruptured Intracranial Aneurysms ◽  
One Year

Background: Unruptured intracranial aneurysms (UIAs) are treated using endovascular treatment or microsurgical clipping. The safety and efficacy of treatments have not been compared in a randomized trial. Methods: We randomly allocated clipping or coiling to patients with 3-25mm UIAs judged treatable both ways. The primary outcome was treatment failure, defined as: initial failure of aneurysm treatment, intracranial hemorrhage or residual aneurysm on one year imaging. Secondary outcomes included neurological deficits following treatment, hospitalization >5 days, overall morbidity and mortality and angiographic results at one year. Results: 136 patients were enrolled from 2010 through 2016 and 134 patients were treated. The one-year primary outcome, available for 104 patients, was reached in 5/48 (10.4% (4.5%-22.2%)) patients allocated surgical clipping, and 10/56 (17.9% (10.0%-29.8%)) patients allocated endovascular coiling (OR: 0.54 (0.13, 1.90), P=0.40). Morbidity and mortality (mRS>2) at one year occurred in 2/48 (4.2% (1.2%-14.0%)) and 2/56 (3.6% (1.0%-12.1%)) patients allocated clipping and coiling respectively. New neurological deficits (15/65 vs 6/69; OR: 3.12 (1.05, 10.57), P=0.031), and hospitalizations beyond 5 days (30/65 vs 6/69; OR: 8.85 (3.22,28.59), P=0.0001) were more frequent after clipping. Conclusions: Surgical clipping led to greater initial treatment-related morbidity than endovascular coiling. At one year, the superior efficacy of clipping remains unproven and in need of randomized evidence.

One-Year Morbidity and Mortality Rates Associated with Clipping Unruptured Intracranial Aneurysms

2019 ◽  
Author(s):  
Khodayar Goshtasbi ◽  
Ronald Sahyouni ◽  
Alice Wang ◽  
Edward Choi ◽  
Gilbert Cadena ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Unruptured Intracranial Aneurysms ◽  
One Year

Long-term Economic Impact of Coiling vs Clipping for Unruptured Intracranial Aneurysms

Neurosurgery ◽  
2013 ◽  
Vol 72 (6) ◽  
pp. 1000-1013 ◽  
Author(s):  
Shivanand P. Lad ◽  
Ranjith Babu ◽  
Michael S. Rhee ◽  
Robbi L. Franklin ◽  
Beatrice Ugiliweneza ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Intracranial Aneurysms ◽  
The United States ◽  
Endovascular Coiling ◽  
Complication Rates ◽  
Surgical Clipping ◽  
Unruptured Intracranial Aneurysms ◽  
Reoperation Rates

Abstract BACKGROUND: Treatment of unruptured intracranial aneurysms (UIAs) involves endovascular coiling or aneurysm clipping. While many studies have compared these treatment modalities with respect to various clinical outcomes, few studies have investigated the economic costs associated with each procedure. OBJECTIVE: To determine the reoperation rate, postoperative complications, and inpatient and outpatient costs associated with surgical or endovascular treatment of patients with UIAs in the United States. METHODS: We utilized the MarketScan database to examine patients who underwent surgical clipping or endovascular coiling procedures for UIAs from 2000 to 2009, comparing reoperation rates, complications, and angiogram and healthcare resource use. Propensity score matching techniques were used to match patients. RESULTS: We identified 4,504 patients with surgically treated UIAs, with propensity score matching of 3,436 patients. Reoperation rates were significantly lower in the clipping group compared to the coiling group at 1- (P < .001), 2- (P < .001), and 5 years (P < .001) following the procedure. However, postoperative complications (immediate, 30 and 90 days) were significantly higher in those undergoing surgical clipping. Although hospital length of stay and costs were higher in the clipping group for the index procedure, the number of postoperative angiograms and outpatient services used at 1, 2, and 5 years were significantly higher in the coiling group. CONCLUSION: Though surgical clipping resulted in lower reoperation rates, it was associated with higher complication rates and initial costs. However, overall costs at 2 and 5 years were similar to endovascular coiling due to the significantly higher number of follow-up angiograms and outpatient costs in these patients.

scholarly journals Interest of Flow Diversion Prostheses in the Management of Unruptured Intracranial Aneurysms

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Xavier Armoiry ◽  
Mélanie Paysant ◽  
Daniel Hartmann ◽  
Gilles Aulagner ◽  
Francis Turjman
Keyword(s):  
Intracranial Aneurysms ◽  
New Technology ◽  
Flow Diversion ◽  
Current Status ◽  
Metallic Surface ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Unruptured Intracranial Aneurysms ◽  
Endovascular Approach ◽  
Wide Neck

Flow diversion prostheses represent a new endovascular approach aimed at treating patients with large wide-neck aneurysms. Our objective is to present this new technology, to review the clinical studies on efficacy, and to emphasize its current limits. Flow diversion prostheses consist of a cylinder made of a large number of braided microfilaments providing a large metallic surface when deployed and inducing a blood flow diversion outside the aneurysm. Two different brands are currently available. Clinical data supporting their efficacy are currently limited to six non comparative cohort studies that included between 18 and 107 patients. Procedural implantation was shown to be feasible in more than 90% and safe with a thirty-day mortality between 2.8 and 5.5%. Complete occlusion rates at twelve months varied between 85.7 and 100%. Even though promising, the current status of flow diversion prostheses needs further evaluation with randomized, prospective, clinical trials with comparison to conventional strategies including endovascular coiling or surgical clipping.

scholarly journals Clinical Outcomes After Endovascular and Microsurgical Treatment of Very Small Intracranial Aneurysms: Report of a Consecutive Series and Meta-analysis

2020 ◽  
Author(s):  
Jianfeng Zheng ◽  
Xiaochuan Sun ◽  
Xiaodong Zhang
Keyword(s):  
Intracranial Aneurysms ◽  
Data Extraction ◽  
Meta Analysis ◽  
Neurological Complication ◽  
Neurological Deficits ◽  
Endovascular Coiling ◽  
Consecutive Series ◽  
Microsurgical Treatment ◽  
Microsurgical Clipping ◽  
Mesh Terms

Abstract Objective: We conducted a systematic review and meta-analysis of studies evaluating endovascular coiling or microsurgical clipping of very small intracranial aneurysms (IAs), including 126 patients treated in our center.Data Sources: The electronic database of PubMed, Embase, and Web of Science were systematically searched for studies on endovascular or microsurgical treatment of very small IAs. The search was performed by using the keywords and medical subject heading (MeSH) terms: “intracranial aneurysm,” “cerebral aneurysm,” “outcome,” “endovascular,” “coil,” “embolization,” “coiling,” “surgical,” “neurosurgical,” “microsurgical,” “clip,” “clipping,” “small,” and “tiny” in both AND and OR combinations.Study Selection: Only studies of very small (Size ≤ 3 mm) ruptured or unruptured IAs patients undergoing endovascular coiling or microsurgical clipping were included.Data Extraction: Data collection and quality assessment were conducted independently by two authors.Data Synthesis: A total of 6 studies provided data on 362 very small UIAs and 9 studies provided data on 703 very small RIAs. Of 362 patients with very small UIAs, 6 (1.7%) cases had operation-related neurological deficits, and no patient died. Of 731 patients with very small RIAs, the morbidity and mortality were 13.0% and 4.7%, respectively. Morbidity due procedure-related complications was 8.3% (95% CI, 3.5% to 13.1%) in coiled very small RIAs patients compared with 20.6% (95% CI, 10.5% to 30.8%) in clipped very small RIAs patients. Mortality due to procedure-related complications was 5.3% (95% CI, 2.9% to 7.7%) in coiled very small RIAs patients compared with 4.7% (95% CI, 2.0% to 7.3%) in clipped very small RIAs patients. No significant differences were found in the incidence of poor outcomes observed between microsurgical and endovascular treatment for very small RIA patients (RR, 1.38; 95% CI, 0.99 - 1.93; P = 0.06).Conclusions Very small UIAs can be treated effectively and safely with good long-term outcomes. However, very small RIAs patients are at high risk of poor outcome and the incidence of neurological complication should not be ignored.

scholarly journals Early diffusion-weighted MRI lesions after treatment of unruptured intracranial aneurysms: a prospective study

2017 ◽  
Vol 126 (4) ◽  
pp. 1070-1078 ◽  
Author(s):  
Johannes Platz ◽  
Marlies Wagner ◽  
Erdem Güresir ◽  
Se-Jong You ◽  
Juergen Konczalla ◽  
...  
Keyword(s):  
Prospective Study ◽  
Intracranial Aneurysms ◽  
Endovascular Coiling ◽  
Diffusion Weighted Mri ◽  
Lesion Load ◽  
Clinical Trial Registration ◽  
Microsurgical Clipping ◽  
Surgical Access ◽  
Diffusion Weighted ◽  
Unruptured Intracranial Aneurysms

OBJECTIVE Diffusion-weighted MRI was used to assess periprocedural lesion load after repair of unruptured intracranial aneurysms (UIA) by microsurgical clipping (MC) and endovascular coiling (EC). METHODS Patients with UIA were assigned to undergo MC or EC according to interdisciplinary consensus and underwent diffusion-weighted imaging (DWI) 1 day before and 1 day after aneurysm treatment. Newly detected lesions by DWI after treatment were the primary end point of this prospective study. Lesions detected by DWI were categorized as follows: A) 1–3 DWI spots < 10 mm, B) > 3 DWI spots < 10 mm, C) single DWI lesion > 10 mm, or D) DWI lesion related to surgical access. RESULTS Between 2010 and 2014, 99 cases were included. Sixty-two UIA were treated by MC and 37 by EC. There were no significant differences between groups in age, sex, aneurysm size, occurrence of multiple aneurysms in 1 patient, or presence of lesions detected by DWI before treatment. Aneurysms treated by EC were significantly more often located in the posterior circulation (p < 0.001). Diffusion-weighted MRI detected new lesions in 27 (43.5%) and 20 (54.1%) patients after MC and EC, respectively (not significant). The pattern of lesions detected by DWI varied significantly between groups (p < 0.001). Microembolic lesions (A and B) found on DWI were detected more frequently after EC (A, 14 cases; B, 5 cases) than after MC (A, 5 cases), whereas C and D were rare after EC (C, 1 case) and occurred more often after MC (C, 12 cases and D, 10 cases). No procedure-related unfavorable outcomes were detected. CONCLUSIONS According to the specific techniques, lesion patterns differ between MC and EC, whereas the frequency of new lesions found on DWI is similar after occlusion of UIA. In general, the lesion load was low in both groups, and lesions were clinically silent. Clinical trial registration no.: NCT01490463 (clinicaltrials.gov)

Direct Costs of Surgical Clipping and Endovascular Coiling of Unruptured Intracranial Aneurysms

2006 ◽  
Vol 22 (1) ◽  
pp. 40-45 ◽  
Author(s):  
Patricia H.A. Halkes ◽  
Marieke J.H. Wermer ◽  
Gabriël J.E. Rinkel ◽  
Erik Buskens
Keyword(s):  
Intracranial Aneurysms ◽  
Direct Costs ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Unruptured Intracranial Aneurysms
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