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Endovascular coiling versus neurosurgical clipping in patients with a ruptured basilar tip aneurysm
  1. E Lusseveld1,
  2. E H Brilstra4,
  3. P C G Nijssen1,
  4. W J J van Rooij2,
  5. M Sluzewski2,
  6. C A F Tulleken5,
  7. D Wijnalda3,
  8. R L L A Schellens1,
  9. Y van der Graaf6,
  10. G J E Rinkel4
  1. 1Department of Neurology, St Elisabeth Hospital, Tilburg, Netherlands
  2. 2Department of Radiology, St Elisabeth Hospital, Tilburg
  3. 3Department of Neurosurgery, St Elisabeth Hospital, Tilburg
  4. 4Department of Neurology, University Medical Centre, Utrecht, Netherlands
  5. 5Department of Neurosurgery, University Medical Centre, Utrecht
  6. 6Julius Centre for Patient Oriented Research, University of Utrecht, Utrecht
  1. Correspondence to:
 Dr P C G Nijssen, Department of Neurology, St Elisabeth Hospital, PO Box 90151, 5000 LC Tilburg, Netherlands;
 p.nijssen{at}elisabeth.nl

Abstract

Objectives: To compare endovascular coiling with neurosurgical clipping of ruptured basilar bifurcation aneurysms.

Methods: Patient and aneurysm characteristics, procedural complications, and clinical and anatomical results were compared retrospectively in 44 coiled patients and 44 patients treated by clipping. The odds ratios for poor outcome (Glasgow outcome scale 1, 2, 3) adjusted for age, clinical condition, and aneurysm size were assessed by logistic regression analysis.

Results: In the endovascular group, five patients (11%) had a poor outcome v 13 (30%) in the surgical group; the adjusted odds ratio for poor outcome after coiling v clipping was 0.28 (95% confidence interval, 0.08 to 0.99). Procedural complications were more common in the surgical group. Optimal or suboptimal occlusion of the aneurysm immediately after coiling was achieved in 41 patients (93%). Clipping was successful in 40 patients (91%).

Conclusions: The results suggest that embolisation with coils is the preferred treatment for patients with ruptured basilar bifurcation aneurysms.

  • basilar artery
  • aneurysm
  • embolisation
  • subarachnoid haemorrhage

https://doi.org/10.1136/jnnp.73.5.591

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    Footnotes

    • Competing interests: none declared.