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Observational Study
. 2022 May 15;62(5):231-237.
doi: 10.2176/jns-nmc.2021-0249. Epub 2022 Apr 7.

Japanese Subarachnoid Aneurysm Trial of Neurosurgical Clipping versus Endovascular Coiling in 1863 Patients with Ruptured Intracranial Aneurysms

Koreaki Irie  1   2 , Yuichi Murayama  2 , Mitsuyoshi Urashima  3 , Fusao Ikawa  4 , Hirotoshi Sano  5 , Akira Sato  6
Affiliations
Observational Study

Japanese Subarachnoid Aneurysm Trial of Neurosurgical Clipping versus Endovascular Coiling in 1863 Patients with Ruptured Intracranial Aneurysms

Koreaki Irie et al. Neurol Med Chir (Tokyo). .

Abstract

This is a post hoc multivariate analysis of the modified World Federation of Neurosurgical Societies (WFNS) grading project, multicenter prospective observational study including 38 neurosurgical institutions across Japan. Japan Neurosurgical Society WFNS grading committee conducted a modified WFNS grading project as a nationwide prospective registry study. We investigate the clinical outcome of both surgical and endovascular interventions after aneurysmal subarachnoid hemorrhage (SAH) in Japan. A total of 792 patients received surgical intervention and 417 patients received endovascular treatment. Eight hundred patients were female, and 409 patients were male. The mean age was 61.5 ± 13.7 years. At 3 month follow-up, there was no statistically significant difference in good clinical outcome between surgical (68.2%) and endovascular (60.9%) group (odds ratio, 0.89; 95% confidence interval, 0.68-1.16; p = 0.381). Unfavorable outcome rate was 31.8% (238 patients) in the surgical group and 39.1% (154 patients) in the endovascular group. Male, elderly people, modified Rankin scale condition before onset, high-grade modified WFNS clinical grading scale, intracerebral hematoma, posttreatment normal pressure hydrocephalus, and neurological deficit due to symptomatic vasospasm were risk factors for the clinical outcome. Treatment modality was not a statistical factor for clinical outcomes. Surgical clipping has still a major role in the management of SAH in Japan. The present study was not a randomized controlled study, but clinical outcome is not influenced by treatment modalities.

Keywords: clip occlusion; coil embolization; intracranial aneurysm; outcomes; subarachnoid hemorrhage.

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Conflict of interest statement

Dr. Murayama reports grants from Stryker, Siemens, NTT Docomo and Asahi Intec.

No other authors have conflicts of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

Fig. 1
Fig. 1
Incidence of symptomatic vasospasm and normal pressure hydrocephalus by treatment group.
Fig. 2
Fig. 2
Clinical outcomes at discharge and at 3 months after treatment.
Fig. 3
Fig. 3
Odds ratio for mRS at 3 months after treatment adjusted by covariates.
See this image and copyright information in PMC

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