Outcomes of Endovascular Coiling versus Surgical Clipping in the Treatment of Ruptured Intracranial Aneurysms

Abstract

Objective: The effects of treatment modality (endovascular coiling or surgical clipping) on incidence of cerebral vasospasm and infarction following aneurysmal subarachnoid haemorrhage (aSAH) remain controversial. This study compared outcomes between endovascular coiling versus surgical clipping to treat patients with acute (< 72 h) aSAH. Methods: Patients with aSAH were randomized to receive endovascular or surgical treatment. All patients underwent clinical assessments, angiography and brain computed tomography. Results: Data from 186 patients were analysed: 94 in the endovascular group and 92 in the surgical group. Demographics and severity of aSAH were comparable between the groups. Incidence of symptomatic vasospasm, cerebral infarction and complete occlusion were significantly lower in the endovascular coiling group than in the surgical clipping group. Good clinical recovery 12 months after aSAH was seen in 75.0% and 69.7% of surviving patients in the endovascular versus coiling group, respectively. Conclusions: In this study, coiling yielded less symptomatic vasospasm, cerebral infarction and complete occlusion than surgical clipping, with no between-group differences in clinical outcome.