Introduction: Landmark clinical trials have assessed complications associated with clipping and coiling of ruptured intracranial aneurysms (RIAs). However, few studies have evaluated the two procedures in a large cohort of patients outside the clinical trial setting. We aimed to compare post-operative complications in patients undergoing clipping vs. coiling for RIAs over the past decade.
Methods: We utilized the Truven MarketScan database examining patients who underwent clipping or coiling for RIAs from 2000-2009. The impact of the two procedures on post-operative complications within 90 days of the initial procedure was assessed using unadjusted comparisons and adjusted logistic regression models.
Results: A total of 5,266 patients were included in the study (2,517 coiling and 2,749 clipping). A significantly higher rate of hemorrhage (2.9% vs. 1.9%) [p = 0.024] and infection (3.0% vs. 1.5%) [p < 0.001] occurred in the clipping group. Rates of pulmonary embolism (PE) (2.7% vs. 2.2%) [p = 0.235], pneumonia (15.5% vs. 15.1%) [p = 0.658], and vasospasm (8.1% vs. 7.8%) [p = 0.699] were all higher in clipped patients, although these trends were not significant. In regression analysis, clipping was associated with significantly higher rates of hemorrhage (Odds Ratio [OR] 1.56; 95% CI 1.09, 2.25; p = 0.016) and infection (OR 2.16; 95% CI 1.45, 3.20; p < 0.001). Clipping was associated with fewer instances of angioplasty within 90 days (1.8% vs 3.4%) [p < 0.001] (OR 0.53; 95% CI 0.37, 0.76; p < 0.001), while having a non-significant trend towards a higher need for shunting (14.3% vs. 13.7%) [p= 0.541]. The mortality rate was similar between the cohorts (1.5% vs. 1.3%) [p = 0.616].
Conclusions: As practiced in the US over the last decade, patients undergoing coiling for RIAs experienced lower rates of hemorrhage and infection, but significantly higher rates of angioplasty compared to those who underwent surgical clipping.
Patient Care: The current research compares the complications profiles and outcomes for the two major treatment modalities for ruptured intracranial aneurysms as practiced in the United States over the last decade. This knowledge will help empower neurosurgeons to make more informed decisions about the safest treatment modalities for these patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Gain an understanding of the complication profiles of clipping vs. coiling as practiced in the United States over the last decade in real-world practice , 2) Learn how the current findings fit into the overall literature such as in the clinical trial setting, 3) make more informed decisions in the treatment of patients with ruptured intracranial aneurysms.