A total of 1,010 patients (711 surgically clipped, 299 treated with coiling) were included in the study. Maximum duration of follow-up was 9.6 years for clipped patients and 8.9 years for coiled patients. Patients treated with coiling were older, more likely to have smaller aneurysms, and less likely to have middle cerebral artery aneurysms. Rerupture of the aneurysm at 14 months occurred in one patient initially treated with coiling. Aneurysm retreatment after one year was more frequent in patients treated with coiling, but major complications were rare during retreatment.
"Because it is less invasive, coiling may be the first choice of treatment for many patients," Johnston said, "but there are a number of issues to be considered. With coiling, a patient should have follow-up, including another angiogram. Also, with coiling, there is the possibility of having to have another coiling procedure. With clipping, it's over and done."
"Johnston and colleagues have conducted a seminal study in responding to the single most important question in the management of intracranial aneurysms, namely, the comparative long-term results of endovascular coiling versus intracranial clipping," said Charles B. Wilson, MD, MSHA, ScD, professor of neurosurgery emeritus and senior advisor and surgery program coordinator, UCSF Global Health Sciences. "The answer provided by this report is validation of the anticipated favorable outcome of coiling, a result that compares in critical respects with the established outcomes of surgical clipping. I congratulate the authors and their collaborators."
In addition to UCSF Medical Center, study sites were Barrow Neurological Institute
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Contact: Vanessa deGier
vdegier@pubaff.ucsf.edu
415-514-1592
University of California - San Francisco
26-May-2006