Although results of a previous trial suggested that coiling was superior to surgical clipping one year after treatment, a lack of data on long-term outcomes has been a major concern, according to neurologist S. Claiborne Johnston, MD, working at San Francisco’s branch of University of California.
There are two main courses of treatment for an aneurysm: clipping the aneurysm, which involves invasive brain surgery, or coiling, which is a procedure in which a small catheter is placed into the groin and threaded up to the brain where a small platinum wire is released into the aneurysm to clot it off from the inside.
"While it is true that some aneurysms can only be treated with clipping and some only with coiling, most patients can be treated with either method," Johnston explained. "This leaves the physician and the patient in the awkward position to decide which is best. Without good data on long term results, the choice is difficult and may be based on purely anecdotal evidence or the preference of the physician."
A total of 1,010 patients (711 surgically clipped, 299 treated with coiling) were included in the study. Maximum duration of follow-up was 9.6 years for clipped patients and 8.9 years for coiled patients. Patients treated with coiling were older, more likely to have smaller aneurysms, and less likely to have middle cerebral artery aneurysms. Rerupture of the aneurysm at 14 months occurred in one patient initially treated with coiling. Aneurysm retreatment after one year was more frequent in patients treated with coiling, but major complications were rare during retreatment.
"Because it is less invasive, coiling may be the first choice of treatment for many patients," Johnston said, "but there are a number of issues to be considered. With coiling, a patient should have follow-up, including another angiogram. Also, with coiling, there is the possibility of having to have another coiling procedure. With clipping, it's over and done."
MEDICA.de; Source: University of California - San Francisco