Current Options in Clipping Versus Coiling of Intracranial Aneurysms: to Clip, to Coil, to Wait and Watch

Incidence of Seizures or Epilepsy After Clipping or Coiling of Ruptured and Unruptured Cerebral Aneurysms in the Nationwide Inpatient Sample Database: 2002-2007

BACKGROUND:

It is not clear whether treatment modality (clipping or coiling) affects the risk of seizures after treatment for cerebral aneurysms.

OBJECTIVE:

To determine whether there is an increased risk of seizures after clipping vs coiling.

METHODS:

Hospitalizations for clipping or coiling of ruptured and unruptured aneurysms were identified in the Nationwide Inpatient Sample Database for 2002 to 2007 by International Classification of Diseases 9th Revision codes for subarachnoid hemorrhage or unruptured cerebral aneurysm and codes for clipping or coiling. Clipping and coiling were compared for the combined primary endpoint of seizures or epilepsy. The analysis was adjusted for patient-specific and hospital-specific factors using generalized linear models with generalized estimated equations.

RESULTS:

There were 10 899 hospitalizations for ruptured aneurysms (6593 clipping, 4306 coiling), and 9686 hospitalizations for unruptured aneurysms (4483 clipping, 5203 coiling). For ruptured aneurysm patients, clipping had a similar incidence of seizures or epilepsy compared with coiling (10.7% vs 11.1%, respectively, adjusted odds ratio: 0.596; 95% confidence interval: 0.158-2.248; P = .445 after adjustment for patient-specific and hospital-specific factors). For unruptured aneurysm patients, clipping was associated with a significantly higher risk of seizures or epilepsy (9.2%) compared with coiling (6.2%) (adjusted odds ratio: 1.362; 95% confidence interval: 0.155-1.606; P < .001 after adjustment for patient-specific and hospital-specific factors). Seizures or epilepsy were significantly associated with longer hospitalizations (P < .01) and higher hospital charges (P < .0001), except in coiled unruptured aneurysm patients, in which seizures or epilepsy were not significantly associated with hospital charges (P = .31).

CONCLUSION:

In unruptured cerebral aneurysm patients, clipping is associated with a higher risk of seizures or epilepsy.

Selective embolization of unruptured intracranial aneurysms is associated with low retreatment rate

INTRODUCTION

To report long-term imaging findings of 101 patients with 129 unruptured intracranial aneurysms (UIA) treated by embolization.

METHODS

A retrospective review of our prospectively maintained database identified all patients with an UIA treated by embolization with coils only and with a minimal 12-month imaging follow-up. The clinical charts, procedural data, and angiographic results were reviewed.

RESULTS

Between March 2004 and June 2009, 101 patients with 129 UIA were identified (71 women/30 men, mean age = 51.4 years). Ninety-four aneurysms (73%) were large (10-25 mm), and 35 (27%) were small (<10 mm). Aneurysms mean size was 10.7 mm (median, 9 mm; range 3-22 mm); 87 UIA (67.5%) had a small neck (<4 mm or neck/sac ratio < 0.7), and 42 (32.5%) had a wide neck (> or =4 mm or neck/sac ratio > or = 0.7). Selective coiling with bare/coated coils was performed in 125 cases and four cases, respectively. The balloon-assisted technique was used in 47 cases (36.4%). Only one patient experienced a symptomatic complication (thromboembolism) and kept a slight hemiparesis. Immediate results included 77 complete occlusions (59.7%), 45 neck remnants (34.9%), and 7 incomplete occlusions (5.4%). Mean imaging follow-up of 32 months showed 104 stable occlusions (80.6%), 12 further thrombosis (9.3%), 7 major recanalizations (5.4%), and 6 minor recanalizations (4.7%). Retreatment was required in seven wide-necked and/or large aneurysms including four treated with coated coils. No bleeding occurred during follow-up.

CONCLUSION

Selective embolization of UIA is associated with stable long-term anatomical results and low retreatment rate.