title: Efficacy and Safety of Treatment of Ruptured Intracranial Aneurysms.
abstract: OBJECTIVE
  To compare the treatment results of ruptured aneurysms treated endovascularly with aneurysms treated with microsurgical clipping.
  
  
  METHODS
  This prospective multicenter study recorded and analyzed 661 cases of ruptured intracranial aneurysms with consecutive subarachnoid hemorrhage treated between 1997 and 2014 at 2 large medical centers. Endovascular treatment was performed in 271 cases, and microsurgical treatment was performed in 390 cases. The treatment modality was chosen by neuroradiologists and vascular neurosurgeons and was classified by predetermined decision criteria.
  
  
  RESULTS
  Symptomatic ischemic stroke occurred in 46 patients (17.0%) in the endovascular group versus 26 patients (6.7%) in the microsurgery group (odds ratio [OR] = 2.86; 95% confidence interval [CI], 1.72-4.76; P < 0.0001). There was a significantly better occlusion rate (OR = 11.48; 95% CI, 5.10-25.83; P < 0.0001) in the microsurgery group compared with the endovascular group. The rebleeding rate was significantly lower in the microsurgery group (OR = 14.90; 95% CI, 1.90-117.13; P = 0.00085). No patient required retreatment in the microsurgery group, whereas 23 patients required retreatment in the endovascular group (P < 0.0001). There was no significant difference regarding the low direct mortality rate of coil embolization versus microsurgical clipping (P = 0.21).
  
  
  CONCLUSIONS
  Microsurgical clipping shows a lower rate of treatment-associated complications and a higher occlusion rate of ruptured intracranial aneurysms than coil embolization. The individual evaluation and decision process for choice of treatment modality in this study is very effective.
authors.affiliation: Department of Neurosurgery, Paracelsus Medical University, Nuremberg, Bavaria, Germany. Electronic address: alexander.hammer@klinikum-nuernberg.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Hammer
authors.affiliation: Department of Neurosurgery, Paracelsus Medical University, Nuremberg, Bavaria, Germany.
authors.forename: Anahi
authors.initials: A
authors.lastname: Steiner
authors.affiliation: Department of Neurosurgery, Paracelsus Medical University, Nuremberg, Bavaria, Germany.
authors.forename: Ghassan
authors.initials: G
authors.lastname: Kerry
authors.affiliation: Department of Neurosurgery, Paracelsus Medical University, Nuremberg, Bavaria, Germany.
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Ranaie
authors.affiliation: Department of Neurosurgery, Paracelsus Medical University, Nuremberg, Bavaria, Germany.
authors.forename: Eduard
authors.initials: E
authors.lastname: Yakubov
authors.affiliation: Department of Neurology, Paracelsus Medical University, Nuremberg, Bavaria, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Lichtenstern
authors.affiliation: Institute of Radiology and Neuroradiology, Klinikum Nuremberg, Nuremberg, Bavaria, Germany.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Baer
authors.affiliation: Department of Anatomy 2, University of Erlangen-Nuremberg, Erlangen, Bavaria, Germany.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Hammer
authors.affiliation: Department of Neurosurgery, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kunze
authors.affiliation: Department of Neurosurgery, Paracelsus Medical University, Nuremberg, Bavaria, Germany.
authors.forename: Hans-Herbert
authors.initials: HH
authors.lastname: Steiner
mesh_terms: D017542:Aneurysm, Ruptured / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D020521:Stroke / Q000209:etiology; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000601:surgery
keywords: Clip occlusion; Coil embolization; Intracranial aneurysm; Subarachnoid hemorrhage; Vascular disorders