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Neuroscience: Coiling Best Option for Unruptured Cerebral Aneurysm

Mortality and morbidity higher with surgical clipping, especially in the elderly

Endovascular coiling is superior to surgical clipping in the treatment of unruptured cerebral aneurysm, according to a study published recently in Stroke. This effect became more pronounced with age.

Subarachnoid hemorrhage stemming from unruptured cerebral aneurysm is relatively rare. Thus, intervention must be well-justified. Prior research had suggested that age had a negative effect on outcomes in both surgical and endovascular treatment, but there were no hard data. The authors of the current study thus used the United States National Inpatient Sample to evaluate outcomes in patients treated for unruptured aneurysm. Treatment consisted of either clipping or coiling, and occurred between 2001 and 2008. For analysis, 63,940 participants were divided into four age groups: younger than 50 years, 50 to 64 years, 65 to 79 years, and 80 years and older.

The authors found endovascular coiling caused significantly less morbidity and mortality than surgical clipping. People 65 years and older who underwent clipping had a mortality rate of 2.5 percent, as compared to 0.9 percent for people who had a coil procedure. Rates of discharge to a long-term facility were also much worse for clipping patients: 28 percent versus 7.4 percent. In patients 80 years or older, the differences were even more marked. In this age group, mortality was nearly 10-times higher for clipped patients. And one-third of clipped patients were discharged to a long-term care facility, compared to less than 10 percent of coiled patients. Overall, younger patients fared better with both coiling and clipping.

Source: Brinjikji W, Rabinstein AA, Lanzino G, et al. 2011. Effect of age on outcomes of treatment of unruptured cerebral aneurysms: a study of the National Inpatient Sample 2001-2008. Published on March 24, 2011 on the Stroke website.