Hidenori Suzuki1, Waro Taki. 1. Department of Neurosurgery, Mie University Graduate School of Medicine, Mie, Japan. suzuki02@clin.medic.mie-u.ac.jp
Abstract
INTRODUCTION: It is still controversial if the selection of treatment modality (clip or coil) affects cerebral vasospasm development following aneurysmal subarachnoid hemorrhage (SAH). MATERIALS AND METHODS: We enrolled 579 SAH patients in the Prospective Registry of Subarachnoid Aneurysms Treatment project, and these patients were treated either microsurgically or endovascularly within 12 days of onset. The incidence of vasospasm was compared between patients treated with clipping and coiling. RESULTS: Clipping (282 patients) was preferably performed for small aneurysms with a wide neck or middle cerebral artery aneurysms and was followed by cerebrospinal fluid drainage; coiling (297 patients) was preferred for older patients, larger, internal carotid artery and posterior circulation aneurysms, or treatment during a nonacute stage and more frequently followed by antithrombotic treatment. Univariate analyses showed that vasospasm-induced cerebral infarct occurred more frequently in clipped patients than in coiled patients, but this difference disappeared after multivariate analyses. Higher incidence of vasospasm-induced cerebral infarct after clipping was explained by the fact that clipping was selected more for the ruptured middle cerebral artery aneurysm with massive SAH or hematoma, in which vasospasm more frequently occurred. CONCLUSIONS: Treatment modalities (clip or coil) may not significantly affect the incidence of vasospasm.
INTRODUCTION: It is still controversial if the selection of treatment modality (clip or coil) affects cerebral vasospasm development following aneurysmal subarachnoid hemorrhage (SAH). MATERIALS AND METHODS: We enrolled 579 SAHpatients in the Prospective Registry of Subarachnoid Aneurysms Treatment project, and these patients were treated either microsurgically or endovascularly within 12 days of onset. The incidence of vasospasm was compared between patients treated with clipping and coiling. RESULTS: Clipping (282 patients) was preferably performed for small aneurysms with a wide neck or middle cerebral artery aneurysms and was followed by cerebrospinal fluid drainage; coiling (297 patients) was preferred for older patients, larger, internal carotid artery and posterior circulation aneurysms, or treatment during a nonacute stage and more frequently followed by antithrombotic treatment. Univariate analyses showed that vasospasm-induced cerebral infarct occurred more frequently in clipped patients than in coiled patients, but this difference disappeared after multivariate analyses. Higher incidence of vasospasm-induced cerebral infarct after clipping was explained by the fact that clipping was selected more for the ruptured middle cerebral artery aneurysm with massive SAH or hematoma, in which vasospasm more frequently occurred. CONCLUSIONS: Treatment modalities (clip or coil) may not significantly affect the incidence of vasospasm.