Higher Incidence of In-Hospital Complications in Patients With Clipped Versus Coiled Ruptured Intracranial Aneurysms

Abstract

on behalf of the Investigators of the Registry of the Canadian Stroke NetworkBackground and Purpose-After aneurysmal subarachnoid hemorrhage (SAH), patients with clipped aneurysms have a higher incidence of neurocognitive deficits and seizures compared with patients with coiled aneurysms. It remains unknown if patients with clipped aneurysms also have a higher incidence of other in-hospital complications. Methods-We used data from the Registry of the Canadian Stroke Network on consecutive patients admitted to hospital with aneurysmal SAH. Patients who died within 2 days after admission were excluded. Baseline characteristics, incidence of various in-hospital complications within 30 days after admission, length of stay, poor functional outcome (modified Rankin Scale score at discharge of Ն3), and mortality were compared between patients with clipped versus coiled aneurysms. Results-Of the 931 patients, 548 (59%) were clipped and 383 (41%) coiled. Baseline characteristics were similar.Compared with patients with coiled aneurysms, patients with clipped aneurysms had a higher incidence of in-hospital complications (

Endothelin Receptor Antagonists for Aneurysmal Subarachnoid Hemorrhage

“…These complications have been associated with worse functional outcomes in previous studies. [12][13][14] The lack of effect on functional outcome of endothelin receptor antagonists also can be explained by a lack of effect on the incidence of both vasospasm-related infarctions and any new cerebral infarctions. Whereas there is general consensus that vasospasm is associated with neurological deterioration, cerebral infarction, poor functional outcome, and case fatality after SAH, causal relationships are subject to discussion.…”

Coil Embolization versus Clipping for Ruptured Intracranial Aneurysms: A Meta-Analysis of Prospective Controlled Published Studies

“…Our meta-analysis of these published trials shows that the odds of poor outcome are higher after surgical treatment than after endovascular treatment, despite a higher early risk of rebleeding from the target aneurysm after coil embolization. Furthermore, subgroup analyses from these clinical trials have indicated that the risks of seizures, 11 delayed cerebral ischemia, 12 ischemic lesions on MR imaging, 13 and in-hospital complications 14 are lower after coil embolization than after surgical clip ligation. A subgroup analysis of patients enrolled in the ISAT also showed improved cognitive outcome after coilingcompared with surgery.…”

Treatment of Aneurysmal Subarachnoid Haemorrhage in Germany: A Nationwide Analysis of the Years 2005-2009

“…Data from the Nationwide In-Patient Sample of the United States from 2002 to 2008 showed a relative increase of 40% in the utilisation of coiling in aSAH [4]. Vergouwen et al [25] also reported an increase in the usage of coiling from 2002 to 2008 in aSAH patients for Ontario, Canada. Our hospitalisation rates of aSAH potentially underestimate the true incidence of aSAH, because the preclinical mortality of aSAH ranges from 11 to 12% [26,27].…”