Clipping versus coiling for intracranial aneurysms

Area of Science:

• Neurosurgery
• Interventional Neurology
• Vascular Neurology

Background:

• Anterior circle of Willis aneurysms pose significant risks.
• Surgical clipping and endovascular coiling are primary treatment modalities.
• Comparative effectiveness of these treatments remains debated.

Purpose of the Study:

• To compare the outcomes of clipping versus coiling for anterior circle of Willis aneurysms.
• To evaluate treatment efficacy based on aneurysm status (bleeding vs. non-bleeding).
• To assess long-term results, including neurological status and quality of life.

Main Methods:

• A cohort of 165 consecutive patients undergoing treatment for aneurysms.
• Assessment included risk of death, Glasgow Outcome Scale (GOS), modified Rankin Scale (mRS), and quality of life (EORTC QLQ-C30).
• Follow-up averaged over four years.

Main Results:

• No significant overall difference in early or late outcomes between clipping and coiling.
• Coiling showed better outcomes for bleeding aneurysms, notably in quality of life scores (p=0.02).
• Clipping demonstrated superior early results for non-bleeding aneurysms, with more excellent GOS scores (p<0.03) and fewer complications (p=0.02).

Conclusions:

• Treatment outcomes for anterior circle of Willis aneurysms do not differ significantly overall between clipping and coiling.
• Coiling is associated with better outcomes in patients with bleeding aneurysms.
• Clipping appears more advantageous for patients with non-bleeding aneurysms.