title: Short-Term Outcome of Clipping Versus Coiling of Ruptured Intracranial Aneurysms Treated by Dual-Trained Cerebrovascular Surgeon: Single-Institution Experience.
abstract: OBJECTIVE
  Studies that showed endovascular coiling of ruptured intracranial aneurysms (RAs) to be superior to microsurgical clipping have compared dedicated endovascular interventionists versus open cerebrovascular surgeons. This is the first study to evaluate outcomes of coiling versus clipping of RAs treated by a dual-trained cerebrovascular surgeon using a specific intervention protocol.
  
  
  METHODS
  The prospectively maintained database was reviewed for all patients with RAs undergoing endovascular coiling (± stenting) or clipping by the senior author (dual-trained vascular neurosurgeon) between July 2010 and April 2015.
  
  
  RESULTS
  Of the 252 patients identified, 70 underwent clipping and 182 underwent endovascular treatment. The mean and median time to last follow-up were 179.6 and 176.5 days in the endovascular cohort and 203.9 and 154.0 days in the surgical cohort. There was no difference in age, gender, World Federation of Neurosurgical Societies grade and Fisher grade, mean aneurysm size, and length of stay in the hospital/intensive care unit. Clipping had a higher proportion of middle cerebral artery aneurysms (37.1% vs. 8.8%; P < 0.001) and a lower proportion of aneurysms in the remaining locations (P < 0.001). 34.5% of the endovascular cohort and 32.9% of the clipping cohort were discharged home. There was no difference in modified Rankin Scale score at first or latest follow-up. Most had no significant disability. Mortality of endovascular treatment was 13.2% compared with 10.0% in clipping, and 16.5% versus 18.6% at the latest follow-up (both nonsignificant). The rate of conversion from coiling to clipping was 25.0%.
  
  
  CONCLUSIONS
  RA treatment should be individualized, with clipping and coiling being 2 complementary arms. Assessment of patient and aneurysm characteristics along with the advantages of both techniques provides an optimal therapeutic modality.
authors.affiliation: Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Zanaty
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.affiliation: Department of Neurosurgery and Radiology, University of Miami, Miami, Florida, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
authors.forename: Badih
authors.initials: B
authors.lastname: Daou
authors.affiliation: Department of Anesthesiology, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Todd
authors.affiliation: Department of Anesthesiology, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA.
authors.forename: Emine
authors.initials: E
authors.lastname: Bayman
authors.affiliation: Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA.
authors.forename: James
authors.initials: J
authors.lastname: Torner
authors.affiliation: Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA. Electronic address: david-hasan@uiowa.edu.
authors.forename: David
authors.initials: D
authors.lastname: Hasan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods / Q000592:standards; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods / Q000592:standards*; D011446:Prospective Studies; D066231:Surgeons / Q000592:standards*; D013525:Surgical Instruments / Q000592:standards*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Clipping; Coiling; Endovascular; Management; Ruptured cerebral aneurysm; Subarachnoid hemorrhage