Artikel
Management in aneurysmal subarachnoid hemorrhage: A prospective study of outcome comparing early surgical versus endovascular treatment in 361 cases
Behandlunsgstrategien bei der aneurysmatischen Subarachnoidalblutung: Eine prospektive Untersuchung an 361 Fällen zum Vergleich zwischen mikrochirurgischer und endovaskulärer Therapie
Suche in Medline nach
Autoren
Veröffentlicht: | 23. April 2004 |
---|
Gliederung
Text
Objective
This prospective study was conducted to document the influence of treatment modality, surgical (ST) versus endovascular techniques (ET), on clinical outcome in acute aneurysmal subarachnoid hemorrhage.
Methods
A total of 361 patients (1997-2001) were initially assigned either to surgical, 246 aneurysms, or endovascular treatment, 115 aneurysms. Using the WFNS grading scale, 197 patients were grade I+II (ST 138/56% vs. ET 59/51%), 74 patients were grade III (ST 49 vs. ET 25) and 90 patients were grade IV and V (ST 59/23.8% vs. ET 31/26.8%). There were no statistically significant differences in clinical characteristics between the two treatment groups, besides a greater freqency of posterior circulation aneurysms treated by ET (23.1% vs. 3.4%) and a slightly higher amount of poor grade aneurysms in the endovascular group (26.8% vs. 23.8%).
Results
Technique-related complication rates turned out to be higher in ET patients (17.1% vs. 5.7%), but the overall morbidity looked similar for both groups (ST 10/4% vs. 6/5.2%). In WFNS grade I+II aneurysms clinical outcome was regulary excellent using the Glasgow-Outcome-Scale (GOS 4 and 5), independent of the employed techniques (ST 124/89% vs. ET 50/85%). Less favourable results in grade I+II showed 12 of 138 surgical and 7 of 59 endovascular treated patients. In poor grade aneurysms, 24 patients (41%) after clipping showed good results (7/23% in the endovascular group), but mortality remains high (ST 17/29% vs. ET 15/49%).
Conclusions
Clinical outcome seems comparable after surgical and endovascular treatment of ruptured intracranial aneurysms. The higher technique-related morbidity in endovascular treatment, which is in contrast to the results of the ISAT study, may be leaded to a elevated amount of poor grade aneurysms in this group and. The long-term efficacy of endovascular treatment in preventing rebleeding still remains open.