Neurosurgical Clipping versus Endovascular Coiling for treating Ruptured Intracranial Aneurysm - A study of 98 patients from Western Sweden

Abstract

Abstract Neurosurgical Clipping versus Endovascular Coiling for treating Ruptured Intracranial Aneurysm – A study of 98 patients from Western Sweden, Degree Project thesis - Programme in Medicine, Hugo Jakobsson 2015, Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden Background and purpose A ruptured intracranial aneurysm can be treated either by endovascular coiling (EVT) or neurosurgical clipping (NST). International Subarachnoid Aneurysm Trial (ISAT), a multicenter prospective randomized study, was conducted to compare the two treatment alternatives. Criticism has been raised against the low external validity of the study. The purpose of this study was to analyze the ISAT material collected at Sahlgrenska university hospital (SU) to compare the treatment modalities in the patient population of a single center. Method The protocols from ISAT were reviewed and a database was created. The primary end-points were neurological outcome, assessed with modified Rankin scale (mRS), at two months, one year and five years. Length of stay in intensive care unit (ICU), neurosurgical ward, total period under care, rate of shunt dependent hydrocephalus (SDHC), occurrence of epileptic seizures, rebleeding and need for retreatment were also studied. Results This study found a good neurological outcome (mRS 0-2) in 76.9%, 84.4% and 76.9% of the EVT-patients at two months, one year and five years respectively. The corresponding figures for the NST-group were 69.6%, 78.3% and 78.3%. Six (11.5%) EVT-patients developed SDHC, 5 (9.6%) EVT-patients had at least one epileptic seizure. Seven (15.2%) EVT-patients developed SDHC and 7 (15.2%) had at least one epileptic seizure. EVT-patients spent on average 8.8 (SD 7.6) days in ICU, 16.8 (SD 8.8) days in neurosurgical ward and 44.3 (SD 85.4) days total under care. The NSTpatients spent on average 10.6 (SD 7.9) days in ICU, 18.7 (SD 7.8) days in neurosurgical ward and 62.0 (SD 77.4) days total under care. Conclusions EVT entails a better neurological outcome than NST at two months and one year, but the difference diminishes over time. EVT is followed by shorter periods in ICU, neurosurgical ward and total period under care. The risk of SDHC is equal for the methods, although patients with a high Fisher grade and high age treated with NST are at lower risk than those treated with EVT and vice versa for patients with low Fisher grade and low age.