1167. Outcomes Following Endovascular Coiling vs Open Surgical Clipping of Ruptured Anterior Communicating Artery Aneurysms: A Matched Cohort Analysis
Authors: Samir Sur, MD; Anil Mahavadi, BS; Stephanie Chen, MD; Marie Christine-Brunet, MD; David McCarthy, BS; Eric Peterson, MD; Dileep Yavagal, MD; Robert Starke, MD (Miami, FL)
Equipoise exists in selecting the optimal treatment modality for many ruptured aneurysms of the anterior communicating artery region. Although published data supports an endovascular approach when feasible, concerns regarding durability of coil embolization remain and an open approach is often favored in younger patients presenting with minimal neurological disturbance. Here we examined the outcomes in patients treated at an academic, subspecialized tertiary care center, matched by age and clinical/radiographic presentation.
Institutional review board approval was obtained and a retrospective review of records was conducted to identify patients that were treated for aneurysmal subarachnoid hemorrhage between January 2012 and September 2018. Patient demographics, clinical and operative data, and outcome measures were recorded. Patients treated by open surgical clipping were matched in a 1:1 fashion by age and Hunt and Hess and Fisher score for comparison.
20 patients presenting with minimal neurological deficit (HH <= 3) due to rupture of anterior communicating artery aneurysm who underwent open surgical clipping were identified and matched in a 1:1 fashion with similar patients who underwent endovascular coiling. Overall mean mRS at discharge for the endovascular group was 3.0 compared to 3.6 in the clipping group. The rate of symptomatic vasospasm requiring treatment was identical between groups (15%). The requirement for permanent CSF diversion was lower in the clipping group (15% vs 20%). 2 patients (10%) in the coiling group underwent a second embolization procedure for definitive treatment of a residual or recurrent aneurysm neck, without additional morbidity.
Although the rate of retreatment is higher for patients treated by endovascular coiling vs open clipping for ruptured anterior communicating artery aneurysms, clinical outcomes were slightly better. The data suggests that modern endovascular techniques, including dome protection with subsequent definitive treatment, can achieve outcomes matching open surgery in expert hands in selected patients.