TY - JOUR
T1 - The effect of clipping and coiling in acute severe subarachnoid hemorrhage after international subarachnoid aneurysmal trial (ISAT) results
AU - Kato, Yoko
AU - Sano, H.
AU - Dong, P. T.
AU - Panji, N.
AU - Itezawa, Y.
AU - Hayashi, J.
AU - Kanno, T.
PY - 2005/8
Y1 - 2005/8
N2 - Cerebral aneurysms are treated by two methods: direct microsurgical clipping and endovascular coiling. Both are selected based on definite guidelines for clinicoradiological criteria as follows: Endovascular therapy comprising of GDC embolization, CSF wash-out with UK or TP A were performed in cases with Hunt and Kosnik grade 4 (GCS 7, 8), and grade 5 (without hydrocephalus or intracranial hemorrhage), age > 70 years, subacute stage (4-14 days of vasospasm), basilar aneurysm and peripheral MCA/PCA aneurysms. Microsurgical clipping with a drainage procedure was performed in cases with Hunt and Kosnik grades 0-3, grade 4 (GCS 9-12), age less than 70 years, grade 5 with hydrocephalus or intracerebral hematoma and acute stage (0-3 days after bleed). The patient's outcome was measured using COS (Glasgow outcome score) at the time of discharge. In our series of severe (poor grade) SAH cases, 120 cases underwent clipping and 59 cases underwent coiling. Although they accounted for 37.8% and 48% of total SAH cases, respectively, the outcome was satisfactory. Good recovery and moderate disability, together termed "favorable outcome" was found in 69.16% of clipping cases and 44.06% of coiling cases. Clipping had a better outcome than coiling in cases of acute severe SAH in our series. The golden hour resuscitation, pre-hospital care and the adjunctive treatment strategies like hypothermia are discussed. A critical appraisal of the ISAT of microsurgical clipping versus coiling is used for comparison of our results.
AB - Cerebral aneurysms are treated by two methods: direct microsurgical clipping and endovascular coiling. Both are selected based on definite guidelines for clinicoradiological criteria as follows: Endovascular therapy comprising of GDC embolization, CSF wash-out with UK or TP A were performed in cases with Hunt and Kosnik grade 4 (GCS 7, 8), and grade 5 (without hydrocephalus or intracranial hemorrhage), age > 70 years, subacute stage (4-14 days of vasospasm), basilar aneurysm and peripheral MCA/PCA aneurysms. Microsurgical clipping with a drainage procedure was performed in cases with Hunt and Kosnik grades 0-3, grade 4 (GCS 9-12), age less than 70 years, grade 5 with hydrocephalus or intracerebral hematoma and acute stage (0-3 days after bleed). The patient's outcome was measured using COS (Glasgow outcome score) at the time of discharge. In our series of severe (poor grade) SAH cases, 120 cases underwent clipping and 59 cases underwent coiling. Although they accounted for 37.8% and 48% of total SAH cases, respectively, the outcome was satisfactory. Good recovery and moderate disability, together termed "favorable outcome" was found in 69.16% of clipping cases and 44.06% of coiling cases. Clipping had a better outcome than coiling in cases of acute severe SAH in our series. The golden hour resuscitation, pre-hospital care and the adjunctive treatment strategies like hypothermia are discussed. A critical appraisal of the ISAT of microsurgical clipping versus coiling is used for comparison of our results.
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U2 - 10.1055/s-2005-870930
DO - 10.1055/s-2005-870930
M3 - Article
C2 - 16172968
AN - SCOPUS:25844460141
SN - 0946-7211
VL - 48
SP - 224
EP - 227
JO - Minimally Invasive Neurosurgery
JF - Minimally Invasive Neurosurgery
IS - 4
ER -