Hong Kong Med J. 2007 Aug;13(4):271-8. Epub 2007 Jun 4.
Yu SC, Wong GK, Wong JK, Poon WS.
Department of Diagnostic Radiology and Organ Imaging, The Chinese University of
Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. simonyu@cuhk.edu.hk
OBJECTIVES. Using specific selection criteria to determine whether endovascular
coiling as compared to neurosurgical clipping is associated with significant
benefits, in terms of 1-year clinical outcomes and consumption of hospital
resources, for the treatment of ruptured intracranial aneurysms in Hong Kong
Chinese patients. DESIGN. Retrospective study. SETTING. University teaching
hospital, Hong Kong. PATIENTS. Records of outcomes of 169 consecutive Chinese
patients, who were treated with endovascular coiling (n=80) or surgical clipping
(n=89), were reviewed. All patients were followed up clinically for a mean of 55
(standard deviation, 201) months and radiologically with sequential digital
subtraction angiography at 6 and 18 months after treatment. RESULTS. The mean
ages of patients were 56 (standard deviation, 13) years for the coiling group,
and 57 (standard deviation, 13) years for the clipping group (P=0.575). The
median aneurysm size was 4 mm in both groups (P=0.898). The severity of
subarachnoid haemorrhage in the two groups did not differ (P=0.619). The rate of
death or permanent disability leading to dependency (Glasgow Outcome Scale, 1-3)
at 1 year was significantly lower in the coiling group (12/80, 15%) as compared
to the clipping group (30/89, 34%) [P=0.005], resulting in a risk reduction of
19% (95% confidence interval, 6-32%). There were significantly more frequent
admissions into the intensive care unit in the clipping group (P<0.001); the
median duration of intensive care unit stay was 2 days (vs 0 days in the coiling
group). The incidence of subsequent treatment procedures for residual or
recurrent aneurysm was more common in the coiling group (13/80 vs 3/89; P=0.004).
CONCLUSION. Endovascular coiling as compared to neurosurgical clipping for
treatment of patients with ruptured intracranial aneurysms is associated with
significant benefits in terms of a reduced need for intensive care unit
admissions and better general clinical outcomes in Hong Kong Chinese patients.