Single centre experience of surgical and endovascular treatment 97 seen at post-procedural imaging in 14.2% of the patients having undergone endovascular treatment and in 4.3% of those treated by surgery. This group of neurosurgically treated aneurysms probably forms a selected population because post-treatment imaging was not standard procedure in the first years of inclusion. In case of doubt as to whether the aneurysm had been occluded satisfactorily or in patients with multiple aneurysms when one or more aneurysms had remained untreated, post-clipping imaging was more likely to be performed. Even in this selected population, complete aneurysm occlusion occurred significantly more often after surgical treatment compared to endovascular treatment (p < 0.001). Progressive coil compaction after endovascular treatment was seen more often when a residual aneurysm was present at post-procedural imaging compared to completely occluded aneurysms and residual necks at post-procedural imaging; however, this difference was not statistically significant (p=0.35). The presence of a residual aneurysm was significantly related to rebleeding (p=0.007). These results are supported by other studies. The Cerebral Aneurysm Rerupture After Treatment (CARAT) study found the degree of aneurysm occlusion to be highly predictive of the risk for re-rupture.15 Willinsky et al found significantly more frequent recanalization in cases with a residual aneurysm, though the rebleeding rates did not show a difference for completely occluded aneurysms or for aneurysms with a neck or residual aneurysm.16 Study limitations The primary goal of the present study was to assess how patient outcome in routine clinical practice relates to those reported in the literature. However, our study was not a randomized trial; therefore, a direct comparison of outcomes of between endovascular and surgical treatment is not strictly valid. The number of patients presenting in our center with an SAH from a ruptured aneurysm is relatively small, but has grown in the past few years. The clinical loss to follow-up in our study is very low (1.1%). However, in 43 patients the clinical follow- up was obtained from structured telephone interviews, and by information provided by the general practitioner. This may make the clinical outcome graded by the mRS less reliable. Postprocedural imaging was available for all patients after endovascular treatment. However post- procedural angiography after surgery was only available for 64.8% of the patients. The use of balloon or Trispan coils in our clinic was low. This treatment was restricted to patients with aneurysms that were not suitable for neurosurgical treatment, and when the aneurysm could not be treated endovascularly without these additional devices. We think that the risk of complications in most cases where an additional device is needed for endovascular treatment is higher than the risk of neurosurgical clipping, while the outcome in the long term is nearly the same.23,24 Conclusion The outcome of management of patients with intracranial aneurysms in a routine clinical setting according to a decision reached by a multidisciplinary team confirms the efficacy of such a policy. Mortality rates are comparable with those in the literature when the frequently poor clinical condition
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