90 Chapter 5 did not receive an intervention, and 79 were treated but did not meet the inclusion criteria (Fig 1). The remaining 403 patients presenting with a ruptured aneurysm were included in this study. Figure 1. Flow diagram of patient selection Treatment protocol Patient selection for either endovascular coiling or surgical clipping was made by a multidisciplinary team, including a neurologist, neurosurgeon, and interventional radiologist. Endovascular coiling was the preferential treatment for all patients admitted to our institution; surgery was limited to those cases not suitable for coiling. Patients presenting with HH 4–5 following a ruptured aneurysm were not eligible for surgical treatment. However, in case of an emergency craniotomy for intracranial decompression in this group of patients, surgical clipping could also be performed. HH 4 or 5 was usually not considered to be a contraindication for endovascular treatment. Endovascular treatment was performed by an interventional neuroradiologist, with the patient under general anesthesia. We used mainly GDCs (Boston Scientific, Natick, Massachusetts). Use of the balloon- assisted technique or TriSpan coils (Boston Scientific) was restricted to patients with aneurysms that were not suitable for neurosurgical treatment and when the aneurysm could not be coiled successfully without these additional devices.
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