title: Adverse events after unruptured cerebral aneurysm treatment: a single-center experience with clipping/coil embolization combined units.
abstract: BACKGROUND
  Indications of clipping (Clip) or coil embolization (Coil) for unruptured cerebral aneurysms (uAN) was not elaborated because prediction of rupture and risk of treatment are difficult. This study aims to determine the risk-benefit analysis of treating uAN by a comprehensive and retrospective investigation of the adverse events and sequelae in patients treated by our Clip/Coil combined units.
  
  
  METHODS
  Clip and Coil were performed in 141 and 80 patients, respectively; Clip for middle cerebral artery AN and Coil for paraclinoid or basilar apex AN. Worsening of modified Rankin scale or mini-mental state examination was defined as major morbidity. Minor morbidity or transient morbidity was defined as other neurologic deficits. Mortality and these morbidities were considered as serious adverse events. Convulsion or events outside the brain were defined as mild adverse events.
  
  
  RESULTS
  Total mortality and major morbidity were low. Incidence of serious adverse events was not significantly different between the Clip and Coil (17 patients [12.1%] and 6 patients [7.5%]), but the number of total adverse events was significantly different (32 patients [22.7%] in Clip vs. 8 patients [10.0%] in Coil). Because mild morbidities were significantly more frequent in the Clip (20 patients [14.2%]) compared with the Coil (2 patients [2.5%]). Convulsion occurred in 11 (7.8%) patients in the Clip but none in the Coil.
  
  
  CONCLUSIONS
  Our combined unit decreased the occurrence of mortality/major morbidity; however, minor adverse effects were common, especially in the Clip group because of many intrinsic problems of Clip itself. This result suggests further consideration for the treatment modality for uAN.
authors.affiliation: Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan. Electronic address: michi@yamaguchi-u.ac.jp.
authors.forename: Michiyasu
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoneda
authors.affiliation: Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ishihara
authors.affiliation: Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shirao
authors.affiliation: Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Sadahiro
authors.initials: S
authors.lastname: Nomura
authors.affiliation: Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Koizumi
authors.affiliation: Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Suehiro
authors.affiliation: Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Hisaharu
authors.initials: H
authors.lastname: Goto
authors.affiliation: Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Sadahiro
authors.affiliation: Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Maruta
authors.affiliation: Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Oka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020771:Anterior Cerebral Artery / Q000473:pathology; D002340:Carotid Artery Diseases / Q000473:pathology; D002544:Cerebral Infarction / Q000209:etiology / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000473:pathology; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D013525:Surgical Instruments; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000473:pathology
keywords: Adverse event; Clip; Coil; outcome; quality of life; unruptured cerebral aneurysm