title: Endovascular Coiling versus Surgical Clipping for Poor-Grade Ruptured Intracranial Aneurysms: Postoperative Complications and Clinical Outcome in a Multicenter Poor-Grade Aneurysm Study.
abstract: Endovascular coiling is an alternative to surgical clipping for ruptured intracranial aneurysms. However, no large multicenter prospective study has compared coiling and clipping in patients with poor-grade ruptured aneurysms. We aimed to determine differences in postoperative complications and clinical outcome between the 2 treatments in this group of patients.
  
  
  
  A Multicenter Poor-Grade Aneurysm Study was a prospective, multicenter, observational registry of consecutive patients who presented with poor-grade ruptured aneurysms. Three hundred sixty-six patients were enrolled from October 2010 to March 2012. "Poor-grade aneurysm" was defined as a World Federation of Neurosurgical Societies grade of IV or V at the time of aneurysm treatment. Two hundred sixty-two patients received aneurysm treatment within 21 days and were included. Clinical outcomes were assessed at discharge and at 6 and 12 months by the modified Rankin Scale.
  
  
  
  One hundred thirty-three (50.8%) patients underwent endovascular coiling. Unadjusted analysis showed that the outcome rate (mRS 0-1 or mRS 0-2) at 6 and 12 months in patients undergoing coiling was higher than that in patients undergoing clipping. In adjusted analyses, there was no statistically significant difference in outcomes at 6 and 12 months between the 2 groups. The risk of radiologic hydrocephalus was higher in patients treated with coiling than that in those treated with clipping (adjusted OR, 3.36; 95% CI, 1.13-10.01; P = .030).
  
  
  
  The long-term outcome in selected patients was similar between endovascular coiling and clipping for poor-grade ruptured aneurysms. The risk of radiologic hydrocephalus was higher after endovascular treatment of poor-grade aneurysms.
authors.affiliation: From the Department of Neurosurgery (B.Z., X.T., Z.L., K.Z., Y.X., M.Z.), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China Department of Neurosurgery (B.Z.), Mayo Clinic, Rochester, Minnesota.
authors.forename: B
authors.identifier: 0000-0002-5562-0392
authors.initials: B
authors.lastname: Zhao
authors.affiliation: From the Department of Neurosurgery (B.Z., X.T., Z.L., K.Z., Y.X., M.Z.), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: X
authors.identifier: 0000-0001-9562-3726
authors.initials: X
authors.lastname: Tan
authors.affiliation: Department of Neurosurgery (H.Y.), The First Affiliated Hospital of Guizhou Medical University, Guiyang, China.
authors.forename: H
authors.identifier: 0000-0002-3473-8498
authors.initials: H
authors.lastname: Yang
authors.affiliation: From the Department of Neurosurgery (B.Z., X.T., Z.L., K.Z., Y.X., M.Z.), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Z
authors.identifier: 0000-0003-3826-8101
authors.initials: Z
authors.lastname: Li
authors.affiliation: From the Department of Neurosurgery (B.Z., X.T., Z.L., K.Z., Y.X., M.Z.), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: K
authors.identifier: 0000-0001-8087-9390
authors.initials: K
authors.lastname: Zheng
authors.affiliation: From the Department of Neurosurgery (B.Z., X.T., Z.L., K.Z., Y.X., M.Z.), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Y
authors.identifier: 0000-0001-9076-7528
authors.initials: Y
authors.lastname: Xiong
authors.affiliation: From the Department of Neurosurgery (B.Z., X.T., Z.L., K.Z., Y.X., M.Z.), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China zhongming158@sohu.com.
authors.forename: M
authors.identifier: 0000-0002-0102-2143
authors.initials: M
authors.lastname: Zhong
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D016896:Treatment Outcome