Universität zu Köln

Pflaeging, Muriel, Kabbasch, Christoph ORCID: 0000-0003-3712-2258, Schlamann, Marc, Pennig, Lenhard, Juenger, Stephanie Theresa, Grunz, Jan-Peter ORCID: 0000-0002-4524-1620, Timmer, Marco, Brinker, Gerrit, Goldbrunner, Roland, Krischek, Boris and Goertz, Lukas (2021). Microsurgical Clipping versus Advanced Endovascular Treatment of Unruptured Middle Cerebral Artery Bifurcation Aneurysms After a ?Coil-First? Policy. World Neurosurg., 149. S. E336 - 9. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1878-8769

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Abstract

OBJECTIVE: Although intracranial aneurysms are increasingly treated endovascularly, microsurgical clipping has been the standard approach for middle cerebral artery (MCA) aneurysms. We compared microsurgical clipping and state-of-the-art endovascular treatment of u nruptured MCA bifurcation aneurysms treated at a neurovascular center following a coil-first policy. METHODS: This single-center study included 148 patients treated for 160 unruptured MCA bifurcation aneurysms. Technical success, complications, clinical outcome, and angiographic results were retrospectively compared. RESULTS: Microsurgical clipping was performed for 120 MCA aneurysms (75%) and endovascular treatment for 40 (25%; conventional coiling: 8, stent-assisted coiling: 16, balloon-assisted coiling: 3, and flow-disruption: 13). Techn ical treatment success was higher in the clipping group (100%) than in the endovascular group (92.5%, P = 0.015). Overall, complications occurred in 16.7% for clipping and in 20.0% for endovascular treatment (P = 0.631). Major ischemic stroke rates were 4.2% in the clipping group and 7.5% in the endovascular group (P = 0.414). At 6 months, a favorable outcome was obtained by 99.2% after clipping and 95.0% after endovascular treatment (P = 0.154). The 6 month complete aneurysm occlusion rates were by trend higher in the clipping group (89.2%) than in the endovascular group (75.9%, P = 0.078). CONCLUSIONS: Microsurgical clipping was associated with a higher technical success rate and tendentially higher complete occlusion than endovascular treatment, with no additional morbidity and similar clinical outcome. On the basis of these results, clipping proves to be the standard treatment option for MCA bifurcation aneurysms. However, endovascular treatment represents a safe and efficient alternative treatment option for patients.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Pflaeging, Muriel UNSPECIFIED UNSPECIFIED UNSPECIFIED Kabbasch, Christoph UNSPECIFIED orcid.org/0000-0003-3712-2258 UNSPECIFIED Schlamann, Marc UNSPECIFIED UNSPECIFIED UNSPECIFIED Pennig, Lenhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Juenger, Stephanie Theresa UNSPECIFIED UNSPECIFIED UNSPECIFIED Grunz, Jan-Peter UNSPECIFIED orcid.org/0000-0002-4524-1620 UNSPECIFIED Timmer, Marco UNSPECIFIED UNSPECIFIED UNSPECIFIED Brinker, Gerrit UNSPECIFIED UNSPECIFIED UNSPECIFIED Goldbrunner, Roland UNSPECIFIED UNSPECIFIED UNSPECIFIED Krischek, Boris UNSPECIFIED UNSPECIFIED UNSPECIFIED Goertz, Lukas UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-577293
DOI:	10.1016/J.WNEu.2021.02.027
Journal or Publication Title:	World Neurosurg.
Volume:	149
Page Range:	S. E336 - 9
Date:	2021
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1878-8769
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language STENT-ASSISTED COILING; INTRACRANIAL ANEURYSMS; EMBOLIZATION; METAANALYSIS; MANAGEMENT; THERAPY; TRIAL; WEB Multiple languages Clinical Neurology; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/57729