title: Fate of clots in patients with subarachnoid hemorrhage after different surgical treatment modality: a comparison between surgical clipping and Guglielmi detachable coil embolization.
abstract: BACKGROUND
  Subarachnoid clot is important in the development of delayed vasospasm after subarachnoid hemorrhage (SAH).
  
  
  OBJECTIVE
  To compare the clearance of subarachnoid clot and the incidence of symptomatic vasospasm in surgical clipping and embolization with Guglielmi detachable coils for aneurysmal SAH.
  
  
  METHODS
  The subjects were 115 patients with Fisher group 3 aneurysmal SAH on computed tomography scan at admission whose aneurysm was treated by surgical clipping (clip group; n = 86) or Guglielmi detachable coil embolization (coil group; n = 29) within 72 hours of ictus. Software-based volumetric quantification of the subarachnoid clot was performed, and the amount of hemoglobin in drained cerebrospinal fluid was measured.
  
  
  RESULTS
  Clearance of the subarachnoid clot on the computed tomography scan was rapid in the clip group until the day after the operation but slow in the coil group (58.9% removed vs 27.8% removed; P = .008). However, postoperative clearance of the clot occurred more rapidly in the coil group. Reduction of the clot until days 3 through 5 did not differ significantly between the 2 groups (72.9% removed vs 75.2% removed). The amount of hemoglobin in the clip group was > 0.8 g/d until day 3 and then gradually decreased (n = 15), but hemoglobin in the coil group remained at > 0.8 g/d until day 5 (n = 17). The incidence of symptomatic vasospasm did not differ between the groups.
  
  
  CONCLUSIONS
  Subarachnoid clot can be removed directly during surgical clipping, which is not possible with endovascular treatment. However, the percentage reduction of the clot on days 3 through 5 did not differ between the 2 groups.
authors.affiliation: Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Ube, Japan. shirao@yamaguchi-u.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shirao
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoneda
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ishihara
authors.forename: Kei
authors.initials: K
authors.lastname: Harada
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Ueda
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sano
authors.forename: Shohei
authors.initials: S
authors.lastname: Kudomi
authors.forename: Yukari
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Tomoko
authors.initials: T
authors.lastname: Shigeeda
authors.forename: Kaori
authors.initials: K
authors.lastname: Nakano
authors.forename: Sadahiro
authors.initials: S
authors.lastname: Nomura
authors.forename: Masami
authors.initials: M
authors.lastname: Fujii
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kato
authors.forename: Michiyasu
authors.initials: M
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation / Q000502:physiology*; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011859:Radiography; D013345:Subarachnoid Hemorrhage / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging / Q000601:surgery*; D013525:Surgical Instruments; D016896:Treatment Outcome