title: Outcomes of ruptured intracranial aneurysms treated by microsurgical clipping and endovascular coiling in a high-volume center.
abstract: OBJECTIVE
  The purpose of this study was to analyze the 3-month outcomes of patients with aneurysmal subarachnoid hemorrhage (SAH) treated from January 2005 to June 2006. This paper describes the outcomes after treatment of aneurysmal SAH and comparison between patients treated by clipping or coiling in a high volume center.
  
  
  METHODS
  A retrospective chart review was performed of records of 195 consecutive patients with SAH. The overall outcome and the pretreatment variables predicting outcomes and the difference between the clipping and coiling groups were analyzed by logistic regression analysis.
  
  
  RESULTS
  A total of 105 (55%) patients had microsurgical clipping and 87 (45%) had endovascular coiling. At 3 months, 69% of patients recovered with no or mild disability. The predictors of a 3-month modified Rankin Scale (mRS) were Hunt and Hess (HH) grade on admission and the presence of intracerebral hemorrhage (ICH). Patients in the coiling group had worse admission grades; they had worse 3-month mRS (2.28 vs 1.73), but this was not significant when the groups were matched (P = .38). Vasospasm rate was significantly higher in the clipping group (66% vs 52%). The immediate incomplete occlusion rate of aneurysms was higher (21.7% vs 7.6%) in the coiling group.
  
  
  CONCLUSIONS
  The overall results of treatment of aneurysmal SAH have improved. There is no significant difference in the outcomes between the patients in the clipping and coiling groups.
authors.affiliation: Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Natarajan
authors.forename: L N
authors.initials: LN
authors.lastname: Sekhar
authors.forename: B
authors.initials: B
authors.lastname: Ghodke
authors.forename: G W
authors.initials: GW
authors.lastname: Britz
authors.forename: D
authors.initials: D
authors.lastname: Bhagawati
authors.forename: N
authors.initials: N
authors.lastname: Temkin
mesh_terms: D017542:Aneurysm, Ruptured / Q000150:complications / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000295:instrumentation; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000628:therapy*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000628:therapy*; D013525:Surgical Instruments; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000209:etiology