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Updated: Jul 11, 2026
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
Use of endovascular coil embolization and surgical clip occlusion for cerebral artery aneurysms
John A Cowan1, John Ziewacz, Justin B Dimick
1Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan 48109-0338, USA. jacowan@umich.edu
Insights
Endovascular treatment for cerebral artery aneurysms (CAAs) is rising, especially for unruptured cases, offering shorter hospital stays. However, surgical clip occlusion remains more common, and patient factors significantly predict mortality.
Area of Science:
- Neurosurgery
- Endovascular Therapy
- Public Health
Background:
- Cerebral artery aneurysms (CAAs) are a significant cause of morbidity and mortality.
- Endovascular treatment (EVT) has emerged as a less invasive alternative to surgical interventions.
- Understanding treatment trends and outcomes is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate patient demographics, treatment approaches (endovascular vs. surgical), and outcomes for cerebral artery aneurysms (CAAs).
- To analyze trends in the utilization of endovascular techniques for CAA treatment.
- To identify predictors of mortality in patients with CAAs.
Main Methods:
- Analysis of the Nationwide Inpatient Sample (NIS) database from 1998 to 2003.
- Inclusion of patients diagnosed with cerebral artery aneurysms (CAAs), both unruptured and ruptured.
- Comparison of outcomes between surgical clip occlusion and endovascular repair strategies.
Main Results:
- Treatment of CAAs increased significantly for unruptured lesions, with a notable rise in endovascular procedures for both unruptured and ruptured cases.
- In 2003, mortality rates for unruptured CAAs were similar between clip occlusion and endovascular repair.
- Endovascular treatment was associated with shorter length of stay (LOS) and higher discharge-to-home rates for unruptured CAAs.
- Aneurysm status, patient age, comorbidities, and hospital volume predicted mortality.
Conclusions:
- Endovascular techniques for cerebral artery aneurysms (CAAs) are increasingly adopted in the US, though surgical clip occlusion remains prevalent.
- For unruptured CAAs, endovascular treatment offers advantages in LOS and discharge disposition.
- Aneurysm status, patient age, comorbidities, and hospital case volume are critical determinants of patient survival.
Object:
In recent years, endovascular treatment of cerebral artery aneurysms (CAAs) has received greater attention. The authors evaluated patient demographics, endovascular and surgical approaches, and basic outcomes in the treatment of CAAs in a nationally representative administrative database.
Methods:
Using the Nationwide Inpatient Sample from 1998 to 2003, diagnosed CAA coded as either an unruptured or ruptured lesion and treated with surgical clip occlusion, wrapping combined with endovascular repair, or endovascular repair alone was included in the present study.
Results:
Treatment of CAAs significantly increased for unruptured (from 4036 to 8334 cases, p = 0.002) but not ruptured (from 9330 to 11,269 cases, p = 0.231) lesions. Endovascular treatment of CAAs in particular also increased in patients with unruptured (from 11 to 43%, p < 0.001) and ruptured (from 5 to 31%, p < 0.001) lesions. In 2003, the mortality rate associated with unruptured CAAs treated using clip occlusion (1.36%) or endovascular repair (1.41%) was similar, whereas rate differences were noted between these treatments for ruptured CAAs (12.7% for clip occlusion compared with 16.6% for endovascular repair; p = 0.05). Endovascular treatment of unruptured CAAs was associated with a shorter length of stay (LOS) and higher rate of discharge to home compared with those for clip occlusion. The LOS was also shorter in patients with endovascularly treated ruptured CAAs. Aneurysm type (odds ratio [OR] 10.1, ruptured lesion), patient age (OR 1.28, each 10 years), comorbid conditions (OR 1.08, each condition), and hospital case volume (OR 0.97, each additional case) were significant predictors of death in the regression model.
Conclusions:
Endovascular techniques for the treatment of CAAs are being used increasingly in the US, although the majority of patients with this pathological entity still undergo surgical clip occlusion. In cases of unruptured CAAs, endovascular treatment is associated with a shorter LOS and higher discharge-to-home rate. Aneurysm status, patient age, comorbid conditions, and hospital case volume are significant predictors of death. Finally, demographic differences exist between the populations presenting with unruptured or ruptured CAAs.
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