Treatment of Ruptured Cerebral Aneurysms – Clip and Coil, Not Clip Versus Coil

Kaku, Yasuhiko; Yamashita, Kentarou; Kokuzawa, Jouji; Hatsuda, Naoki; Andoh, Takashi

doi:10.1007/978-3-211-99373-6_2

Cited by 12 publications

(8 citation statements)

References 11 publications

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“…In that category, there were 15 articles giving related information [ 11 – 18 , 23 , 24 , 26 – 29 ]. There is information about Op-Mo in 14 of them, but only 9 of them contain events [ 11 , 14 , 16 , 22 , 24 , 26 – 29 ]. Twelve contain information about PND and 11 of them demonstrate events [ 11 , 12 , 14 , 17 , 22 – 24 , 26 – 29 ].…”

Section: Resultsmentioning

confidence: 99%

“…The articles which were excluded from that article pool were those which focused on the reoperation management, case reports, systematic reviews, unrelated outcome, co-morbidities, experimental techniques, or one of the two techniques and all those which demonstrated mixed or unclear results, being separated between anterior and posterior circulation. The final article pool contained 20 articles, as appropriate for our meta-analysis [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] (Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

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Clipping versus coiling in posterior circulation intracranial aneurysms: a meta-analysis

et al. 2019

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Background: Posterior circulation intracranial aneurysm (IA) treatment remains challenging, due to the anatomy of the area and the high rupture possibility. Endovascular treatment seems to be more suitable for these aneurysms, but studies focused on endovascular treatment demonstrate a high rate of re-intervention needing. A meta-analysis might offer a clearer view, being useful in a more effective treatment planning. Methods: A systematic search was performed, using the PubMed database platform. The final article pool contained 20 articles. Studied parameters were operative mortality, late mortality, permanent neurologic deficit (PND), and the need for re-intervention (Re-int). We divided patients into two subgroups, those with ruptured and those with unruptured aneurysm. Statistical analysis was performed using appropriate software. Results: In the total population (645 patients), there was a superiority of coiling over clipping in terms of PND and of coiling in terms of Re-int. As regards mortality, there was no clear superiority of one method over the other. Conclusions: The current study came to the conclusion that there is a superiority of coiling over clipping in terms of PND. On the other hand, clipping seems to be superior to coiling in terms of the need for re-intervention. As regards mortality (both operative and late), there is no clear superiority of one method over the other. Studying subgroups of patients (ruptured and unruptured posterior circulation IAs), in terms of PND, there is no superiority of one method over the other. The same goes for Op-Mo on ruptured aneurysms.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Clipping versus coiling in posterior circulation intracranial aneurysms: a meta-analysis

et al. 2019

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“…[7,8] In the literature, most of the patients with ruptured distal AChoA aneurysms underwent an open surgery (clipping or trapping). However, the open surgery is technically challenging because of the difficulty of accurate localization of and clearly exposing the aneurysm due to the deep and narrow operating field, [9] and open surgery is also a more invasive procedure in presence of collateral vessels. Endovascular therapy has become an alternative treatment of ruptured intracranial aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Endovascular therapy of ruptured distal anterior choroidal artery aneurysm associated with moyamoya pattern collateralization secondary to middle cerebral artery occlusion

Oishi

Suga

Nonaka³

2017

IJNS

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We report a case of a ruptured distal anterior choroidal artery (AChoA) aneurysm associated with moyamoya pattern collateralization secondary to the middle cerebral artery occlusion. Patient was successfully treated with the coil embolization of the distal AChoA. This case supports the feasibility and efficacy of the endovascular therapy for the distal AChoA aneurysms in patients with MCA occlusion with moyamoya pattern collateralization.

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“…In MMD without occlusion of the AChA, the trunk and branches of the AChA often develop compensatory dilation and extend to distal regions. The increase in blood flow that results from this collateral circulation in the AChA correlates with a greater incidence of aneurysms in its distal end 33 - 35 . Because distal AChA aneurysms are quite rare, little is known concerning their treatment.…”

Section: Peripheral Artery Aneurysms Associated With MMDmentioning

confidence: 99%

Treatment Strategies for Aneurysms Associated with Moyamoya Disease

Zhang¹,

Xu²,

Zhang³

et al. 2015

Int. J. Med. Sci.

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The treatment of aneurysms associated with moyamoya disease (MMD) is difficult for neurosurgeons, and little is known of strategy options. This report constitutes a comprehensive review of the literature. We summarize the known treatments and their clinical outcomes according to the site of the aneurysm: in major arteries, peripheral arteries, moyamoya vessels, meningeal arteries, or at the site of anastomosis. The literature review indicates that the treatment of MMD-associated aneurysms varies according to the site of the aneurysm and its hemodynamic characteristics. In particular, the treatment for basilar tip aneurysms remains challenging, since both endovascular embolization and direct clipping are difficult. The potential risk for ischemia should be considered in selecting endovascular or surgical approaches. Revascularization surgery, which is important for the treatment of MMD, also determines the clinical treatment outcome of aneurysms associated with MMD.

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Treatment of Ruptured Cerebral Aneurysms – Clip and Coil, Not Clip Versus Coil

Abstract: A combined microsurgical-endovascular approach can achieve the best outcomes for patients with ruptured cerebral aneurysms. Our findings support the policy of "Clip and Coil, not Clip versus Coil."

Cited by 12 publications

References 11 publications

Clipping versus coiling in posterior circulation intracranial aneurysms: a meta-analysis

Clipping versus coiling in posterior circulation intracranial aneurysms: a meta-analysis

Endovascular therapy of ruptured distal anterior choroidal artery aneurysm associated with moyamoya pattern collateralization secondary to middle cerebral artery occlusion

Treatment Strategies for Aneurysms Associated with Moyamoya Disease

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