Coiling of Brain Aneurysms Equal to Clipping

A new study shows that coiling of ruptured brain aneurysms is very effective following long-term follow-up, similar to outcomes with surgical clipping.

There are two main courses of treatment for an aneurysm: clipping the aneurysm, which involves invasive brain surgery, or coiling, which is a procedure in which a small catheter is placed into the groin and threaded up to the brain where a small platinum wire is released into the aneurysm to clot it off from the inside.

In the study, eight institutions with expertise in intracranial aneurysm treatment identified all ruptured saccular aneurysms treated between 1996 and 1998. After an initial medical record review, all patients meeting entry criteria were contacted through a mailed questionnaire or by telephone. The possibility of a re-rupture was judged independently by a neurologist, a neurosurgeon, and a neurointerventional radiologist. A total of 1,010 patients (711 surgically clipped, 299 treated with coiling) were included in the study. Maximum duration of follow-up was 9.6 years for clipped patients and 8.9 years for coiled patients.

Patients treated with coiling were older, more likely to have smaller aneurysms, and less likely to have middle cerebral artery aneurysms. Re-rupture of the aneurysm at 14 months occurred in one patient initially treated with coiling. Aneurysm re-treatment after one year was more frequent in patients treated with coiling, but major complications were rare during re-treatment. The study results were published in the June 2006 issue of Stroke, a publication of the American Heart Association.

"Because it is less invasive, coiling may be the first choice of treatment for many patients,” said lead author neurologist S. Claiborne Johnston, M.D., of the University of California San Francisco (UCSF, USA). "But there are a number of issues to be considered. With coiling, a patient should have follow-up, including another angiogram. Also, with coiling, there is the possibility of having to have another coiling procedure. With clipping, it's over and done.”



Related Links:
University of California San Francisco