Headache improvement after intracranial endovascular procedures in Chinese patients with unruptured intracranial aneurysm: A prospective observational study

To clip or to coil for unruptured intracranial aneurysm?: A protocol of randomized controlled trial

INTRODUCTION

Microsurgical clipping and endovascular coiling are the main methods against unruptured intracranial aneurysm (UIA). The craniotomy of surgical clipping may increase the risk of cerebrospinal fluid leakage and infection, damage the brain tissue, produce excessive stimulation to the nerves and blood vessels around the aneurysm, and cause the corresponding neurological deficit. Endovascular coiling could significantly reduce the mortality and disability rate than surgical clipping technique, which made endovascular coiling to become the first choice for the treatment of UIA. However, the long-term results showed attenuated favorable outcomes of coiling over clipping, so it is still in debate whether to clip or to coil. Therefore, we try to conduct a randomized, controlled, prospective trial to assess the long term safety of endovascular coiling therapy against UIA compared with microsurgical clipping technique.

METHODS

Parallel-group randomization (1:1) is generated through the random number generator in Microsoft Excel 2010. In this trial, blinding to patients, physicians, and outcome assessors is not possible. Endovascular coiling or surgical clipping will be performed once for each patient in treatment group or control group, respectively. The mRS, overall mortality rate, disability rate, morbidity rate, and occurrence of a major aneurysm recurrence measured at 6 month and 1 year will be recorded.

CONCLUSIONS

The findings will be helpful for the choice of endovascular coiling or surgical clipping by assessing the long term efficacy and safety of both operations against UIA.

TRIAL REGISTRATION

OSF Registration number: DOI 10.17605/OSF.IO/QYE9F.

Impact of aneurysm location and endovascular treatment modality on the improvement of headache in patients with unruptured intracranial aneurysms

INTRODUCTION

The use of endovascular therapy (EVT) in patients with unruptured intracranial aneurysms (UIA) is associated with a significant reduction of headache severity. It is still unclear how the treatment modality and the aneurysm location affect headache in these patients. This systematic review and meta-analysis aimed to compare the improvement of headache rates based on the endovascular treatment modality and aneurysm location.

EVIDENCE ACQUISITION

We conducted a complete search through four databases. Original studies that reported the improvement in headache rates in patients that had undergone EVT for UIA based on the treatment modality and location were included in the analysis. Fixed effect meta-analysis was performed to compare them using the odds ratio (OR).

EVIDENCE SYNTHESIS

A total of 180 reports were screened for title and abstract, of which six reports were included in this study. There were 199 patients that underwent stent-assisted coiling and 184 patients who had coiling alone. A total of 75 patients with posterior aneurysms were included as compared to 347 with anterior aneurysms. There was no significant difference between the two treatment modalities regarding the improvement in headache rates (OR=0.591, 95% CI: 0.349-1.003, P=0.051). Additionally, no difference was found in headache improvement rates between posterior and anterior UIA (OR=0.738, 95% CI: 0.434-1.254, P=0.262).

CONCLUSIONS

There was no clear statistical difference between stent-assisted coiling and coiling alone for the improvement of headache in patients with UIA, as well as between posterior and anterior UIA. Future well-conducted large trials that use headache severity scores are warranted to investigate that further.