gms | German Medical Science

Objective: In this prospective study we examined and compared the clinical outcome of patients with aneurysmal subarachnoid haemorrhage depending on the intervention modality (clipping versus coiling).

Method: This study was conducted from 2006 to 2008 on 92 microsurgical (MC), as well as 64 endovascular (EV) treated patients after subarachnoid haemorrhage. The MC-group includes 34 male and 58 female patients with an initial WFNS grade I and II in 50 patients (54%), grade III in 15 patients and grade IV and V in 27 patients (29%). The endovascular group (29 men and 35 women) consists of 31 (48%) patients with the WFNS grade I and II, 11 patients grade III and 22 patients (34%) grade IV and V. There was no essential difference concerning the extent of the aneurysm and the median age (50,1 vs. 51,8 years) regarding these two groups. Almost all aneurysms of the posterior circulation were treated endovascular. The proportion of severe subarachnoid haemorrhage is higher in the EV-group (29% vs. 34%).

Results: Direct complications with consecutive cerebral perfusion disorders were found in 5 cases (5,4%) in the surgical group, and in 12 cases (18,8%) in the endovascular group. There had been a regression of the clinical failures in 3 (MC) respectively 8 patients (EV). Overall, the outcomes for both treatment groups were broadly equivalent. For the 92 microsurgical treated patients, the overall lethality rate was 7%, for WFNS grade I and II in this investigation 0%. The endovascular group featured an overall lethality rate of 18% but with a higher proportion of severe subarachnoid haemorrhage.

Conclusions: In total, unlike the ISAT study, equivalent results are evident regarding the clinical outcome of patients in the direct comparison of the intervention modalities. Probably increased complication rate and lethality rate in the endovascular treated patient group reflects the higher number of cases with higher WFNS grade compared to the MC-group. Regarding continuation and supplementation of this established study, we are able to present preliminary results of a running investigation, illuminating more different aspects of the comparison of these intervention modalities.