Better Outcomes with Treatment by Coiling Relative to Clipping of Unruptured Intracranial Aneurysms in the United States, 2001–2008

Brinjikji, Waleed; Rabinstein, Alejandro A.; Nasr, Deena M.; Lanzino, Giuseppe; Kallmes, David F.; Cloft, Harry J.

doi:10.3174/ajnr.a2453

Cited by 187 publications

(120 citation statements)

References 20 publications

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“…38 From this database, morbidity rates ranging from 13.5% to 27.6% and mortality rates ranging from 0.7% to 3.5% have been reported. 2,3,4,5,6,15,18,19,22,28,41 The objective of this institutional review board-approved prospective study was to assess the feasibility and efficacy of the addition of direct neurological testing during both temporary and permanent clipping of UIAs.…”

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confidence: 99%

“Awake” clipping of cerebral aneurysms: report of initial series

Abdulrauf¹,

Vuong²,

Patel³

et al. 2017

Journal of Neurosurgery

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ABBREVIATIONS ACoA = anterior communicating artery; CVA = cerebrovascular accident; EEG = electroencephalography; ICA = internal carotid artery; LOS = length of stay; MCA = middle cerebral artery; MEP = motor evoked potential; mRS = modified Rankin Scale; NIS = National Inpatient Sample; SSEP = somatosensory evoked potential; UIA = unruptured intracranial aneurysm; VA = vertebral artery. OBJECTIVE Risk of ischemia during aneurysm surgery is significantly related to temporary clipping time and final clipping that might incorporate a perforator. In this study, the authors attempted to assess the potential added benefit to patient outcomes of "awake" neurological testing when compared with standard neurophysiological testing performed under general anesthesia. The procedure is performed after the induction of conscious sedation, and for the neurological testing, the patient is fully awake. METHODS The authors conducted an institutional review board-approved prospective study of clipping unruptured intracranial aneurysms (UIAs) in 30 consecutive adult patients who underwent awake clipping. The end points were the incidence of stroke/cerebrovascular accident (CVA), death, discharge to a long-term facility, length of stay, and 30-day modified Rankin Scale score. All clinical and neurophysiological intraoperative monitoring data were recorded. RESULTS The median patient age was 52 years (range 27-63 years); 19 (63%) female and 11 (37%) male patients were included. Twenty-seven (90%) aneurysms were anterior, and 3 (10%) were posterior circulation aneurysms. Five (17%) had been coiled previously, 3 (10%) had been clipped previously, 2 (7%) were partially calcified, and 2 (7%) were fusiform aneurysms. Three patients developed synchronous clinical neurological and neurophysiological changes during temporary clipping with consequent removal of the temporary clip and reversal of those clinical and neurophysiological changes. Three patients developed asynchronous clinical neurological and neurophysiological changes. These 3 patients developed hemiparesis without changes in neurophysiological monitoring results. One patient developed linked clinical neurological and neurophysiological changes during final clipping that were not reversed by reapplication of the clip, and the patient had a CVA. Four patients with internal carotid artery ophthalmic segment aneurysms underwent visual testing with final clipping, and 1 of these patients required repositioning of the clip. Three patients who required permanent occlusion of a vessel as part of their aneurysm treatment underwent a 10-minute intraoperative clinical respective-vessel test occlusion. The median length of stay was 3 days (range 1-5 days). The median modified Rankin Scale score was 1 (range 0-3). All of the patients were discharged to home from the hospital except for 1 who developed a CVA and was discharged to a rehabilitation facility. There were no deaths in this series. CONCLUSIONS The 3 patients who developed neurological deterioration without a concomitant neurophysi...

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confidence: 99%

“Awake” clipping of cerebral aneurysms: report of initial series

Abdulrauf¹,

Vuong²,

Patel³

et al. 2017

Journal of Neurosurgery

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“…While microsurgical clipping was previously the standard of care, coil embolization has matured rapidly in recent years and is a more frequent treatment alternative with technological advancements and the advent of adjunctive balloon and stent-assisted techniques. 44 Numerous studies have shown a lower periprocedural morbidity and mortality associated with endovascular treatment and lower rates of discharge to long-term care facilities. 44,45 Some authors have suggested that Ͼ90% of aneurysms can now be effectively treated by using endovascular techniques.…”

Section: Efficacy and Safetymentioning

confidence: 99%

“…44 Numerous studies have shown a lower periprocedural morbidity and mortality associated with endovascular treatment and lower rates of discharge to long-term care facilities. 44,45 Some authors have suggested that Ͼ90% of aneurysms can now be effectively treated by using endovascular techniques. 46 However, the durability of coil embolization remains frequently debated due to the increased risk of residual aneurysm components or neck remnants, interval rupture or rebleeding (Ͻ1%), and the additional risk of retreatment.…”

Section: Efficacy and Safetymentioning

confidence: 99%

“…In this study, the combined morbidity and mortality from coiling decreased from 6.2% to 4.3% versus clipping, which decreased from 16.9% to 13.2% during 2001-2008. 44 These outcomes are per procedure, and the risk per patient would increase in cases of retreatment, the latter being negligible after clipping. Renowden et al 47 reported that 6% of 1631 patients required retreatment after coiling of 1834 mostly ruptured aneurysms.…”

Section: Efficacy and Safetymentioning

confidence: 99%

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Should Patients with Autosomal Dominant Polycystic Kidney Disease Be Screened for Cerebral Aneurysms?

Rozenfeld

Ansari

Shaibani

et al. 2013

AJNR Am J Neuroradiol

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SUMMARY:Autosomal dominant polycystic kidney disease is a genetic disorder affecting 1 in 1000 people worldwide and is associated with an increased risk of intracranial aneurysms. It remains unclear whether there is sufficient net benefit to screening this patient population for IA, considering recent developments in imaging and treatment and our evolving understanding of the natural history of unruptured aneurysms. There is currently no standardized screening protocol for IA in patients with ADPCKD. Our review of the literature focused on the above issues and presents our appraisal of the estimated value of screening for IA in the setting of ADPCKD.ABBREVIATIONS: ADPCKD ϭ autosomal dominant polycystic kidney disease; GFR ϭ glomerular filtration rate; IA ϭ intracranial aneurysm; QALY ϭ quality-

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“…1,2 These articles used the National Inpatient Sample (NIS) data base. This samples one-third of all nonfederal hospital discharges in the United States and is a very powerful tool for examining clinical outcomes; it provides a very large sample size.…”

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confidence: 99%

The Treatment of Unruptured Cerebral Aneurysms: Cause for Concern?

Molyneux¹

2011

AJNR Am J Neuroradiol

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Better Outcomes with Treatment by Coiling Relative to Clipping of Unruptured Intracranial Aneurysms in the United States, 2001–2008

Cited by 187 publications

References 20 publications

“Awake” clipping of cerebral aneurysms: report of initial series

“Awake” clipping of cerebral aneurysms: report of initial series

Should Patients with Autosomal Dominant Polycystic Kidney Disease Be Screened for Cerebral Aneurysms?

The Treatment of Unruptured Cerebral Aneurysms: Cause for Concern?

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