Alexander Hammer1, Anahi Steiner2, Ghassan Kerry2, Gholamreza Ranaie2, Eduard Yakubov2, David Lichtenstern3, Ingrid Baer4, Christian M Hammer5, Stefan Kunze6, Hans-Herbert Steiner2. 1. Department of Neurosurgery, Paracelsus Medical University, Nuremberg, Bavaria, Germany. Electronic address: alexander.hammer@klinikum-nuernberg.de. 2. Department of Neurosurgery, Paracelsus Medical University, Nuremberg, Bavaria, Germany. 3. Department of Neurology, Paracelsus Medical University, Nuremberg, Bavaria, Germany. 4. Institute of Radiology and Neuroradiology, Klinikum Nuremberg, Nuremberg, Bavaria, Germany. 5. Department of Anatomy 2, University of Erlangen-Nuremberg, Erlangen, Bavaria, Germany. 6. Department of Neurosurgery, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany.
Abstract
OBJECTIVE: To compare the treatment results of ruptured aneurysms treated endovascularly with aneurysms treated with microsurgical clipping. METHODS: This prospective multicenter study recorded and analyzed 661 cases of ruptured intracranial aneurysms with consecutive subarachnoid hemorrhage treated between 1997 and 2014 at 2 large medical centers. Endovascular treatment was performed in 271 cases, and microsurgical treatment was performed in 390 cases. The treatment modality was chosen by neuroradiologists and vascular neurosurgeons and was classified by predetermined decision criteria. RESULTS: Symptomatic ischemic stroke occurred in 46 patients (17.0%) in the endovascular group versus 26 patients (6.7%) in the microsurgery group (odds ratio [OR] = 2.86; 95% confidence interval [CI], 1.72-4.76; P < 0.0001). There was a significantly better occlusion rate (OR = 11.48; 95% CI, 5.10-25.83; P < 0.0001) in the microsurgery group compared with the endovascular group. The rebleeding rate was significantly lower in the microsurgery group (OR = 14.90; 95% CI, 1.90-117.13; P = 0.00085). No patient required retreatment in the microsurgery group, whereas 23 patients required retreatment in the endovascular group (P < 0.0001). There was no significant difference regarding the low direct mortality rate of coil embolization versus microsurgical clipping (P = 0.21). CONCLUSIONS: Microsurgical clipping shows a lower rate of treatment-associated complications and a higher occlusion rate of ruptured intracranial aneurysms than coil embolization. The individual evaluation and decision process for choice of treatment modality in this study is very effective.
OBJECTIVE: To compare the treatment results of ruptured aneurysms treated endovascularly with aneurysms treated with microsurgical clipping. METHODS: This prospective multicenter study recorded and analyzed 661 cases of ruptured intracranial aneurysms with consecutive subarachnoid hemorrhage treated between 1997 and 2014 at 2 large medical centers. Endovascular treatment was performed in 271 cases, and microsurgical treatment was performed in 390 cases. The treatment modality was chosen by neuroradiologists and vascular neurosurgeons and was classified by predetermined decision criteria. RESULTS: Symptomatic ischemic stroke occurred in 46 patients (17.0%) in the endovascular group versus 26 patients (6.7%) in the microsurgery group (odds ratio [OR] = 2.86; 95% confidence interval [CI], 1.72-4.76; P < 0.0001). There was a significantly better occlusion rate (OR = 11.48; 95% CI, 5.10-25.83; P < 0.0001) in the microsurgery group compared with the endovascular group. The rebleeding rate was significantly lower in the microsurgery group (OR = 14.90; 95% CI, 1.90-117.13; P = 0.00085). No patient required retreatment in the microsurgery group, whereas 23 patients required retreatment in the endovascular group (P < 0.0001). There was no significant difference regarding the low direct mortality rate of coil embolization versus microsurgical clipping (P = 0.21). CONCLUSIONS: Microsurgical clipping shows a lower rate of treatment-associated complications and a higher occlusion rate of ruptured intracranial aneurysms than coil embolization. The individual evaluation and decision process for choice of treatment modality in this study is very effective.
Authors: Alexander Hammer; Anahi Steiner; Ghassan Kerry; Gholamreza Ranaie; Ingrid Baer; Christian M Hammer; Stefan Kunze; Hans-Herbert Steiner Journal: PLoS One Date: 2017-03-03 Impact factor: 3.240
Authors: Alexander Hammer; Anahi Steiner; Gholamreza Ranaie; Eduard Yakubov; Frank Erbguth; Christian M Hammer; Monika Killer-Oberpfalzer; Hans Steiner; Hendrik Janssen Journal: Sci Rep Date: 2018-08-17 Impact factor: 4.379
Authors: Alexander Hammer; Gholamreza Ranaie; Eduard Yakubov; Frank Erbguth; Markus Holtmannspoetter; Hans-Herbert Steiner; Hendrik Janssen Journal: Aging (Albany NY) Date: 2020-04-20 Impact factor: 5.682
Authors: Alexander Hammer; Frank Erbguth; Matthias Hohenhaus; Christian M Hammer; Hannes Lücking; Markus Gesslein; Monika Killer-Oberpfalzer; Hans-Herbert Steiner; Hendrik Janssen Journal: BMC Neurol Date: 2021-01-19 Impact factor: 2.474