96 Chapter 5 Table 7. Data on patients with rebleeding after procedure Age/ Location Size Initial Post procedural Time to Interven- mRS sex (mm) intervention imaging results rebleed (days) tion 48/F MCA bifurcation 8 Coiling Residual aneurysm 1 None 6 56/F ACoA 7 Coiling Residual neck 2 None 6 63/M ACoA 2 Coiling Residual aneurysm 1562 None 6 49/F MCA M2 2 Coiling Residual neck 43 None 6 48/F ACoA 4 Coiling Residual aneurysm 83 Recoiling 4 70/F ACoA 10 Coiling Residual aneurysm 3373 Recoiling 6 44/F ACoA 3 Coagulation Aneurysm regrowth 1396 Reclipping 2 40/F PCoA 5 Clipping ? a 1 None 6 65/M AcoA 5 Clipping Clip slippedb 57 Coiling 2 40/F AcoA 15 Clipping ? a 2 None 6 47/M MCA bifurcation 6 Clipping Residual aneurysm 507 Coiling 3 49/F AcoA 4 Clipping Clip slippedb 12 Reclipping 0 a Indicates no post-procedural imaging was performed b Clip that slipped from the aneurysm became clear at angiography after rebleed. Discussion The primary goal of aneurysm treatment is to prevent aneurysm bleeding or rebleeding, and thereby decrease the risk of death and dependency. This study presents the results of both types of treatment of intracranial aneurysms in symptomatic patients in a routine clinical setting. After a median follow-up period of 33.9 months, 11.6% of the surgically treated and 17.4% of the endovascularly treated patients had died. ISAT reported different mortality rates after a follow-up period of 5 years: 11% after coiling and 14% after surgical treatment.6 These differences can be explained by the inclusion criteria and the clinical status at presentation. In our study, all patients presenting with an intracranial aneurysm were analyzed. In the group undergoing endovascular treatment only 56.4% had a good clinical grading at presentation (HH 1–2), in the surgically treated patients this was 69.4%. ISAT included only patients whose clinical condition was suitable for both coiling and surgical clipping. A clinical grading of HH 1-2 at presentation was seen in 88% of these patients.4-6 At the end of the follow-up period 80.3% and 87.2% of the surviving patients in the surgical and endovascular group respectively were living independently (mRS 1–2). These results are comparable with the ISAT study, which describes a good clinical outcome (mRS 1–2) in 82% and 83% of the surviving patients after surgery and coiling respectively.6 The overall risk of rebleeding tends to be greater after coiling compared to surgical clipping.4,6,15 In ISAT and other published studies, rebleeding rates after surgical treatment varied from 1.1% to 3.2%, while after endovascular treatment the rates varied from 2.1% to 3.5%, depending on the occlusion rates and on the follow-up period.4,6,15-22 In the present study, rebleeding occurred with approximately equal frequency after surgery compared to endovascular treatment, 3.0% and 2.5% respectively. Coiling is known to result in lower rates of complete occlusion compared to microsurgical clipping, which may affect the long-term stability and rates of rebleeding.8-11 In the present study a residual aneurysm was
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