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. 2017 Mar 3;12(3):e0172837.
doi: 10.1371/journal.pone.0172837. eCollection 2017.

Treatment of ruptured intracranial aneurysms yesterday and now

Alexander Hammer  1 , Anahi Steiner  1 , Ghassan Kerry  1 , Gholamreza Ranaie  1 , Ingrid Baer  2 , Christian M Hammer  3 , Stefan Kunze  4 , Hans-Herbert Steiner  1
Affiliations

Treatment of ruptured intracranial aneurysms yesterday and now

Alexander Hammer et al. PLoS One. .

Abstract

Objective: This prospective study is designed to detect changes in the treatment of ruptured intracranial aneurysms over a period of 17 years.

Methods: We compared 361 treated cases of aneurysm occlusion after subarachnoid hemorrhage from 1997 to 2003 with 281 cases from 2006 to 2014. Specialists of neuroradiology and vascular neurosurgery decided over the modality assignment. We established a prospective data acquisition in both groups to detect significant differences within a follow-up time of one year. With this setting we evaluated the treatment methods over time and compared endovascular with microsurgical treatment.

Results: When compared to the earlier group, microsurgical treatment was less frequently chosen in the more recent collective because of neck-configuration. Endovascular treatment was chosen more frequently over time (31.9% versus 48.8%). Occurrence of initial symptomatic ischemic stroke was significantly lower in the clipping group compared to the endovascular group and remained stable over time. The number of reinterventions due to refilled treated aneurysms significantly decreased in the endovascular group at one-year follow-up, but the significantly better occlusion- and reintervention-rate of the microsurgical group persisted. The rebleeding rate in the endovascular group at one year follow-up decreased from 6.1% to 2.2% and showed no statistically significant difference to the microsurgical group, anymore (endovascular 2.2% versus microsurgical 0.0%, p = 0.11).

Conclusion: Microsurgical clipping still has some advantages, however endovascular treatment is improving rapidly.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Microscope-based indocyanine green video angiography supporting the microsurgical occlusion of a ruptured middle cerebral artery aneurysm, which has been tested but is not used as a routine intraoperative device so far.
(A): Intraoperative illustration of the middle cerebral artery aneurysm (arrows). (B): Video angiography showing the perfusion of the untreated aneurysm (arrows). (C): After clipping no perfusion of the aneurysm is detectable any more (arrows).
See this image and copyright information in PMC

References

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