Single centre experience of surgical and endovascular treatment 93 disability, 4 = moderately severe disability, 5 = severe disability and 6 = death. Clinically suspected rebleeding was confirmed by a CT scan of the brain. Angiographic post-procedural follow-up was performed using DSA. The completeness of aneurysm occlusion was assessed using the Raymond classification (complete aneurysm occlusion, residual neck or residual aneurysm).14 In the endovascular treatment group, a post-procedural angiogram was always performed at the end of the coiling procedure. Imaging follow-up of coiled aneurysms was routinely carried out at 6 and 24 months after treatment. In case of increasing coil compaction angiographic follow-up was performed more frequently. Imaging follow-up was performed by DSA (62.4%), and MRA (37.6%). Post-procedural angiography after neurosurgery was not standard practice, but was performed if the neurosurgeon found it necessary. This follow-up was performed by DSA (63.2%), MRA (10.5%) or CTA (26.3%). In case of coil compaction the problem was discussed in a multidisciplinary team including a neurologist, neurosurgeon, and interventional radiologist. An increasing size of the aneurysm remnant was only retreated if this was considered necessary and safe by the multidisciplinary team. Statistics Continuous variables are presented with means and ranges. Categorical data are given as frequencies and percentages and analyzed by T-test, Fisher’s exact test or Chi square test accordingly. A p-value of ч 0.05 was considered to be statistically significant. Results Clinical During the follow-up period, 20 patients (11.6%) died after surgical treatment, 10 (50%) of whom were graded HH 4 or 5 at the time of presentation. Of these 20 deaths, 17 were related to the SAH or treatment of the cerebral aneurysm. The other three patients died of a pancreatic carcinoma (n = 1) or myocardial infarction (n = 2). In the endovascular group 40 patients (17.4%) had died by the end of the follow-up period, 26 of whom (65%) were graded 4 or 5 on the HH at the time of presentation. Thirty- eight deaths were related to the SAH or the coiling of the intracranial aneurysm. One patient died of a lung carcinoma and one died due to cardiac failure. Of the 38 deaths related to the SAH or coiling 10 patients developed vasospasm during the procedure; 6 patients had a thromboembolic complication during the procedure, and 5 patients died after rebleeding. In the other 17 patients, no complications occurred, and they died of a serious preprocedural clinical condition. Clinical follow-up (mean 33.9 months, range 12-106 months) was completed in 339 of the 343 surviving patients (98.9%). Follow-up information was missing for 1 and 3 patients in the surgical and endovascular groups, respectively. Three patients were foreigners, visiting the Netherlands at the time of SAH, and one patient had moved away after the SAH period. The clinical outcome of the surviving patients as expressed by mRS is shown in Table 4. In the surgical and endovascular groups respectively, 122 (80.3%) and 163 (87.2%) were able to live independently (mRS 0-2).
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