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

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.

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 Endovascular Coiling of Aneurysm Remnants after Clipping in Patients with Follow-up

2005 ◽  
Vol 11 (1) ◽  
pp. 41-48 ◽  
Author(s):  
S. Mangiafico ◽  
M. Cellerini ◽  
G. Villa ◽  
F. Ammannati ◽  
L. Paoli ◽  
...  
Keyword(s):  
Treatment Strategy ◽  
Intracranial Aneurysms ◽  
Endovascular Embolization ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Anterior Circulation ◽  
Therapeutic Alternative ◽  
Relative Safety

The vast majority of intracranial aneurysms can be obliterated completely with surgical clipping. However, postoperative remnants occur in about 4 to 8% of patients who undergo postoperative angiography. Endovascular embolization has been successfully performed in patients with postoperative aneurysm remnant and it may represent a therapeutic alternative to surgical reintervention. Twelve aneurysm remnants after surgical clipping were treated with endovascular embolization using GDC. All aneurysms were located in the anterior circulation. Our experience confirms the feasibility and relative safety of this treatment strategy that may be considered a valid alternative to reintervention.

scholarly journals Balloon-Assisted Cannulation for Difficult Anterior Cerebral Artery Access

2017 ◽  
Vol 7 (1-2) ◽  
pp. 48-52
Author(s):  
Varun Naragum ◽  
Mohamad AbdalKader ◽  
Thanh N. Nguyen ◽  
Alexander Norbash
Keyword(s):  
Cerebral Artery ◽  
Paradigm Shift ◽  
Intracranial Aneurysms ◽  
Anterior Cerebral Artery ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
Surgical Clipping ◽  
Ruptured Aneurysms ◽  
Common Location ◽  
Proximal Middle Cerebral Artery

The anterior communicating artery is a common location for intracranial aneurysms. Compared to surgical clipping, endovascular coiling has been shown to improve outcomes for patients with ruptured aneurysms and we have seen a paradigm shift favoring this technique for treating aneurysms. Access to the anterior cerebral artery can be challenging, especially in patients with tortuous anatomy or subarachnoid hemorrhage or in patients presenting with vasospasm. We present a technique for cannulating the anterior cerebral artery using a balloon inflated in the proximal middle cerebral artery as a rebound surface.

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