Single centre experience of surgical and endovascular treatment 89 Introduction Intracranial aneurysms are an important health problem worldwide, affecting about 2% of the population.1 Treatment consists of the exclusion of the malformation from the intracranial circulation to eliminate the risk of bleeding or rebleeding. Intracranial aneurysms can be treated by endovascular coiling or by surgical clipping. Since the introduction of the Guglielmi Detachable Coils (GDCs),1-3 endovascular treatment of intracranial aneurysms has evolved rapidly as an alternative to microsurgical clipping. Coiling has become the preferential treatment since the International Subarachnoid Aneurysm Trial (ISAT) demonstrated its clinical superiority over clipping in patients with a ruptured aneurysm who were eligible for both treatment types.4-6 However, many aneurysms are preferentially treated by either neurosurgery (eg, middle cerebral artery (MCA) aneurysms) or by endovascular treatment (eg, posterior circulation aneurysms).7 Moreover, coiling achieves lower rates of complete occlusion compared with microsurgical clipping, which may affect the long-term stability and rates of rebleeding.8-11 The results of ISAT were based on a selected patient population with aneurysms suitable for both endovascular and surgical treatment in a trial setting. Few data are available on the outcome of patients who are either endovascularly or surgically treated in a routine clinical practice. In our center, intracranial aneurysms are treated either by surgical or by endovascular means, according to a decision reached by a multidisciplinary team that includes a neurologist, neurosurgeon, and interventional radiologist. Therefore, the purpose of the present study was to review the outcomes in a consecutive cohort of patients who were either endovascularly or surgically treated for a ruptured intracranial aneurysm in a routine clinical setting. The outcome was determined by rates of survival, independence, retreatment, and rebleeding after ш1 year of clinical follow-up. Materialsandmethods Patients Between 2000 and 2008, 531 patients harboring one or more intracranial aneurysms were admitted to our institution. We retrospectively reviewed the medical reports, imaging studies, and reports of endovascular and surgical procedures of these patients. Subarachnoid hemorrhage (SAH) was diagnosed by cerebral CT or CSF examination. The aneurysmal origin of the SAH was confirmed by computed tomographic angiography (CTA), magnetic resonance angiography (MRA), or digital subtraction angiography (DSA). The clinical status of the patient was rated by using the Hunt and Hess grading scale (HH).12 All patients received calcium channel blockers. Figure 1 shows the flow diagram of our patient selection. Patients were included in our analysis if they had a ruptured intracranial aneurysm and underwent either surgical or endovascular treatment. Patients were excluded from this analysis if they met any of the following criteria: 1) presenting with non-ruptured intracranial aneurysm, 2) t1 aneurysm treated in another center, 3) both surgical and endovascular treatment applied in the same patient, and 4) aneurysms treated by parent vessel occlusion. One hundred and twenty-eight patients were excluded from the analysis: Forty-nine patients
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