gms | German Medical Science

Objective: There is still considerable heterogeneity between various centers in the allocation of patients in need of treatment of incidental or ruptured intracranial aneurysms either to endovascular embolization or to operative clipping. In our clinic, endovascular treatment is considered the first choice in these patients and operative treatment is performed only in patients not eligible for endovascular treatment due to an unfavorable morphology of the aneurysm. The aim of the present study was to compare the clinical outcomes of patients treated in our clinic with an incidental or a ruptured intracranial aneurysm one and two years after either endovascular or operative treatment.

Method: The study was performed in 240 patients with an incidental (n=74) or a ruptured (n=166) intracranial aneurysm treated in our clinic from January 2009 until December 2012. The outcome was assessed by means of the modified Rankin Scale (mRS) one and two years after endovascular (n=200) or operative (n=40) treatment. The patients were allocated either to a “good outcome” group (mRS 0-2) or a “poor outcome” group (mRS 3-6). The dependency of the clinical outcome from the treatment method was assessed by the chi-square test and the association of a “good outcome” with a treatment method was determined by the odds ratio (OR).

Results: In the present study, 84 % of the aneurysms were located in the anterior circulation and 16 % in the posterior circulation. The great majority (83 %) of the aneurysms not suitable for endovascular treatment due to an unfavorable morphology of the aneurysm and therefore treated operatively were located in the middle cerebral artery. No statistically significant dependence was found between treatment method and clinical outcome one year (p=0.12) and two years (p=0.31) after treatment, although the OR for a “good outcome” was 1.76 times higher one year and 1.45 higher two years after treatment for the endovascular treatment group as compared with the operative treatment group.

Conclusions: In our study, based on patients with an incidental or ruptured intracranial aneurysm for which endovascular treatment was considered first choice, no statistically significant difference in clinical outcome could be found between the two treatment groups (endovascular vs. operative), although the odds for a good outcome were considerably higher for endovascular treatment as compared with operative treatment. These results may confirm our regimen of primary endovascular treatment if possible.