Background: In deciding a treatment for aneurysm occlusion, surgical clipping had long been the main option. In recent years, the use of endovascular coiling technique has seen a substantial rise, leading to discussions on the topic of “clip versus coil” and debating which technique is more favorable.

Objective: To compare microsurgical clipping and endovascular coiling by investigating the ruptured intracranial aneurysm treatment outcomes in a real-world setting, in which the patients included in this study were heterogenous in nature.

Materials and Methods: A retrospective study of 331 patients. Of these, 229 patients underwent surgical clipping and 102 had endovascular coiling. The primary outcome was modified Rankin scale (mRS) at one year, and the secondary outcomes were rate of aneurysm recurrence, cerebral vasospasm, and shunt-dependent hydrocephalus.

Results: Statistically, the authors found no major difference between these two treatment procedures at one year (mRS 0 to 2). Favorable outcomes were 65.5% and 71.6% in clipping and coiling group, respectively (p=0.057). From subgroup analysis of primary outcome, endovascular coiling achieved better results in patients with poor World Federation of Neurosurgical Societies Grading (WFNS) grade (p=0.017) and posterior circulation aneurysms (p=0.018). Coiling showed promising results in poor grade subarachnoid hemorrhage (SAH) patients with 43.8% favorable outcomes. In secondary outcomes, surgical clipping showed more favorable degree of aneurysm obliteration, but with tendency towards cerebral vasospasm. As for shunt-dependent hydrocephalus, there was no difference between the two groups.

Conclusion: Results showed similar clinical outcomes between the two treatment groups. However, endovascular coiling had a tendency to benefit patients with poor clinical grade and posterior circulation aneurysms. The treatment decision should be made with individual patient in mind.

Keywords: Intracranial aneurysms; Microsurgical clipping; Coiling embolization; Aneurysmal subarachnoid hemorrhage

DOI: 10.35755/jmedassocthai.2022.01.13226

Received 14 October 2021 | Revised 22 November 2021 | Accepted 23 November 2021