Hong Kong Med J 2007;13:271-8 | Number 4, August 2007
Endovascular coiling versus neurosurgical clipping for ruptured intracranial aneurysms: significant benefits in clinical outcome and reduced consumption of hospital resources in Hong Kong Chinese patients
Simon CH Yu, George KC Wong, Jeffrey KT Wong, WS Poon
Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
OBJECTIVES. Using specific selection criteria to determine whether endovascular coiling as compared to neurosurgical clipping is associated with significant benefits, in terms of 1-year clinical outcomes and consumption of hospital resources, for the treatment of ruptured intracranial aneurysms in Hong Kong Chinese patients.
DESIGN. Retrospective study.
SETTING. University teaching hospital, Hong Kong.
PATIENTS. Records of outcomes of 169 consecutive Chinese patients, who were treated with endovascular coiling (n=80) or surgical clipping (n=89), were reviewed. All patients were followed up clinically for a mean of 55 (standard deviation, 201) months and radiologically with sequential digital subtraction angiography at 6 and 18 months after treatment.
RESULTS. The mean ages of patients were 56 (standard deviation, 13) years for the coiling group, and 57 (standard deviation, 13) years for the clipping group (P=0.575). The median aneurysm size was 4 mm in both groups (P=0.898). The severity of subarachnoid haemorrhage in the two groups did not differ (P=0.619). The rate of death or permanent disability leading to dependency (Glasgow Outcome Scale, 1-3) at 1 year was significantly lower in the coiling group (12/80, 15%) as compared to the clipping group (30/89, 34%) [P=0.005], resulting in a risk reduction of 19% (95% confidence interval, 6-32%). There were significantly more frequent admissions into the intensive care unit in the clipping group (P<0.001); the median duration of intensive care unit stay was 2 days (vs 0 days in the coiling group). The incidence of subsequent treatment procedures for residual or recurrent aneurysm was more common in the coiling group (13/80 vs 3/89; P=0.004).
CONCLUSION. Endovascular coiling as compared to neurosurgical clipping for treatment of patients with ruptured intracranial aneurysms is associated with significant benefits in terms of a reduced need for intensive care unit admissions and better general clinical outcomes in Hong Kong Chinese patients.
Key words: Aneurysm, ruptured; Cerebral arteries; Embolization, therapeutic; Intracranial aneurysm; Treatment outcome
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