A study led by UCSF neurologist S. Claiborne Johnston, MD, has shown that coiling of ruptured brain aneurysms is very effective during long-term follow-up, similar to outcomes with surgical clipping.
Although results of a previous trial suggested that coiling was superior to surgical clipping one year after treatment, a lack of data on long-term outcomes has been a major concern, according to Johnston. The study results are published in the June 2006 issue of the journal Stroke, a publication of the American Heart Association.
"Aneurysms are very serious. Half of those who suffer a ruptured aneurysm will die from it, and another 30 percent will be permanently disabled," Johnston said. "Aneurysms that rupture once are very likely to bleed again, so treatment is definitely indicated. However, there has been concern that coiling may not work as well to prevent new bleeding, and this has limited its use, particularly in the U.S."
There are two main courses of treatment for an aneurysm: clipping the aneurysm, which involves invasive brain surgery, or coiling, which is a procedure in which a small catheter is placed into the groin and threaded up to the brain where a small platinum wire is released into the aneurysm to clot it off from the inside.
"While it is true that some aneurysms can only be treated with clipping and some only with coiling, most patients can be treated with either method," Johnston explained. "This leaves the physician and the patient in the awkward position to decide which is best. Without good data on long term results, the choice is difficult and may be based on purely anecdotal evidence or the preference of the physician. My hope is that this study will help both patients and physicians make better informed decisions based on that particular patient's situation."
In the study, eight institutions with expertise in intracranial aneurysm treatment identified all ruptured saccular aneurysms treated between 1996 and 1998. After an initial medical record review, all patients meeting entry criteria were contacted through a mailed questionnaire or by telephone. The possibility of a rerupture was judged independently by a neurologist, a neurosurgeon, and a neurointerventional radiologist.