Artikel
Comparison of the clinical course and functional outcome in patients treated with Woven EndoBrigde, microsurgical clipping or endovascular coiling after aneurysmal subarachnoid haemorrhage
Vergleich des klinischen Verlaufs und Outcomes bei Patienten mit aneurysmatischer Subarachnoidalblutung, die mit Woven EndoBrigde, mikrochirurgischem Clipping oder endovaskulärem Coiling behandelt wurden
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Autoren
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Thomas Sauvigny
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Marie Teresa Nawka
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Hamburg, Deutschland
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Jan-Hendrik Buhk
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Hamburg, Deutschland
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Maxim Bester
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Hamburg, Deutschland
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Jan Regelsberger
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Nils Ole Schmidt
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Manfred Westphal
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Patrick Czorlich
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Woven EndoBridge (WEB) devices have been highlighted in securing aneurysm after subarachnoid hemorrhage (SAH) while recent major clinical trials have actually excluded these devices. In an analysis of an unselected “real world” patient group we seek to examine the rational for excluding WEB placement in clinical trials.
Methods: All patients with proven SAH who were either treated with a WEB device, coil embolization or neurosurgical clipping between March 2015 and August 2018 were systematically reviewed. The decision between surgical and endovascular treatment was individually discussed between the attending neurosurgeon and neuro-radiologist based on aneurysm shape and localization etc. Clinical parameters and complications on the intensive care unit (ICU), medical history, mortality rates and favorable outcome at time of discharge using the modified Rankin Scale (mRS) were evaluated and compared between the different treatment approaches. A multivariate logistic regression analysis was used to identify independent factors for the neurological outcome. The level of statistical significance was set at p<0.05. Unfavourable outcome was defined as 3–6 on the mRS.
Results: A total of 201 patients were included. 107 patients received endovascular coil embolization, 56 patients were treated with clipping and in 38 cases a WEB device was placed. Antiplatelet drugs were most frequently administered in the WEB-group with 68.4% (p<0.001). Further clinical parameters (e.g. duration of ventilation and stay on ICU, infections, rate of tracheotomy or shunt-implantation) did not differ between the groups. Higher age (p=0.003) and Hunt-and-Hess-grade (p<0.001), delayed cerebral ischemia (p=0.032) and initial hydrocephalus (p=0.024) were identified as independent predictors for unfavourable outcome in a multivariate regression in the overall cohort, but did not show a different distribution between the three treatment modalities.
Conclusion: In aneurysmal SAH patients WEB placement seems not to provide any advantages or disadvantages compared to coil embolization and neurosurgical clipping in terms of intensive care and early clinical outcome. Since WEB placement is an equivalent treatment option, it seems not justified to exclude this procedure from upcoming clinical SAH trials, yet clinical long-term outcome, stability of aneurysm occlusion and re-treatment rates have to be analyzed in further studies.
