1048. Clipping vs. Coiling for Aneurysmal Subarachnoid Hemorrhage (aSAH): An Analysis of the US Population:

Authors: Robert M. Gramer; Robert Gramer, BS; Harrison Farber, MD; Beiyu Liu, PhD; Syed Adil, BS; Lefko Charalambous, BS; Musa Kiyani; Beth Parente; Fernando Gonzalez; Shivanand Lad, MD, PhD; Ali Zomorodi, MD; Erik Hauck, MD (Toronto, Canada)

Introduction

In the US, more than 30,000 people suffer aneurysmal subarachnoid hemorrhage (aSAH) each year. About half of these patients die within one month of aSAH, with two-thirds of the survivors living with permanent disability. Neurosurgical clipping versus endovascular coiling are the definitive life-saving treatments for intracranial aneurysmal rupture.

Methods

Querying the MarketScan® Database, 8108 adult patients diagnosed with aSAH had either clipping or coiling procedures from 2008 to 2015. 3807 had 12-months of continuous pre-aSAH enrollment, and were included in the analyses. Patients were censored at the time of discontinued enrollment after the diagnosis or the end of study period.

Results

Age, gender, geographical location, insurance type, and Charlson Comorbidity Index (CCI) were similar between treatment groups. 974 (25.6%) received clipping and 2833 (74.4%) received coiling; this ratio remained largely consistent over each of the eight years (min./max. coiling rate=68.2%(2010)/77.3%(2013)) examined. There was no significant difference in the one-year survival rate between the two procedure groups (p-value =0.4651), with a one-year survival percentage was 90.5% for clipping and 89.6% for coiling. Postoperatively, incidence of hydrocephalus (28.0% vs. 22.9%), SIADH/hyposmoarity (15.4% vs. 10.1%), or angioplasty (5.4% vs. 4.0%) was higher in the coiling group. Postoperative brain compression (5.3% vs. 3.7%), infection (1.4% vs. 0.4%), and transient cerebral ischemia or vasospasm (32.3% vs. 27.6%) was higher in the clipping group. The incidence of pulmonary embolism, pneumonia, urinary tract infection, or seizures was comparable between groups.

Conclusions

Postoperative survival, both acutely and long-term, is comparable between aSAH patients treated with clipping or coiling. While, certain complications are relatively more pronounced in each of the respective procedures, overall long-term morbidity and mortality is equal. Taken together, at the US population level, patients treated with clipping or coiling appear to have similar overall outcomes.