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Published on: August 11, 2015
Clipping Versus Coiling for Ruptured MCA Aneurysms Associated with Intracerebral Hematoma Requiring Surgical
Thomas Metayer1,2,3, Chloe Dumot4, Florian Bernard5
1Department of Neurosurgery, University Hospital of Caen, Caen, France. thomas.metayer@neurochirurgie.fr.
Background:
Ruptured middle cerebral artery aneurysm (MCAa) can lead to intracerebral hematoma, and surgical evacuation can be performed in these cases. MCAa can be treated by clipping or before by endovascular therapy (EVT). Our objective was to compare the impact on the functional outcome of MCAa in patients with intracerebral hematoma requiring evacuation.
Methods:
This is a multicenter, retrospective, cohort study with nine French neurosurgical units from January 1, 2013, to December 31, 2020. All participants were adult patients who required evacuation of an intracerebral hematoma. We looked for risk factors for poor outcomes by comparing the baseline characteristics and treatments performed by using the 6-month modified Rankin scale score. Poor outcomes were defined by an modified Rankin scale score of 3-6.
Results:
A total of 162 patients were included. A total of 129 (79.6%) patients were treated by microsurgery, and 33 (20.4%) patients were treated by EVT. In multivariate analysis, factors associated with poor outcomes included hematoma volume, realization of a decompressive craniectomy, occurrence of procedure-related symptomatic cerebral ischemia, occurrence of delayed cerebral ischemia, and EVT. In the propensity score matching analysis (n = 33 per group), poor outcomes were observed in 30% of the patients in the clipping group versus 76% in the EVT group (P < 0.001). These differences may have been related to a longer delay between hospital admission and hematoma evacuation in the EVT group.
Conclusions:
In the specific subgroup of ruptured MCAa with intracerebral hematoma that requires surgical evacuation, clipping with concomitant hematoma evacuation could provide better functional outcomes than EVT followed by surgical evacuation.
Insights
Surgical clipping with hematoma evacuation offers better functional outcomes for ruptured middle cerebral artery aneurysms (MCAa) with intracerebral hematoma compared to endovascular therapy (EVT). This finding aids in selecting optimal treatments for MCAa patients with hematoma.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Interventional Neurology
Background:
- Ruptured middle cerebral artery aneurysms (MCAa) can cause intracerebral hematoma, necessitating surgical evacuation.
- Treatment options for MCAa include surgical clipping and endovascular therapy (EVT).
Purpose of the Study:
- To compare the functional outcomes of MCAa patients with intracerebral hematoma requiring evacuation, focusing on clipping versus EVT.
Main Methods:
- A multicenter, retrospective cohort study involving nine French neurosurgical units (2013-2020).
- Included adult patients requiring intracerebral hematoma evacuation after MCAa.
- Assessed risk factors for poor outcomes using the 6-month modified Rankin Scale score (mRS 3-6).
Main Results:
- 162 patients were analyzed; 129 (79.6%) underwent microsurgery and 33 (20.4%) EVT.
- Multivariate analysis identified hematoma volume, decompressive craniectomy, symptomatic cerebral ischemia, delayed cerebral ischemia, and EVT as factors for poor outcomes.
- Propensity score matching showed significantly higher poor outcomes in the EVT group (76%) versus the clipping group (30%, P < 0.001).
Conclusions:
- For ruptured MCAa with intracerebral hematoma requiring evacuation, clipping with simultaneous hematoma evacuation may yield superior functional outcomes compared to EVT followed by evacuation.
- The findings suggest that surgical clipping may be a more effective treatment strategy in this specific patient subgroup.
