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  • Is there Really a Different Between Clipping and Coiling Across Different Age Populations? A Systemic Review

    Final Number:

    Sitara Koneru BA; Giana Dawod; Luke Mugge; Azedine Medhkour MD, FACS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Endovascular coiling and open clipping are accepted interventions for patients with un-rupture aneurysms within the CNS. While successful, consensus is lacking regarding which intervention is appropriate for a given patient population of a certain age. It is uncertain how efficacy and safety differ among various age groups.

    Methods: A systemic review of the PubMed database was completed using the PRISMA guidelines. Keywords used to define the search included: “Aneurysm”, “Clip”, “Coil”, and “Age”. Papers included focused on the comparison of surgical clipping to endovascular coiling for both ruptured and un-ruptured cerebral aneurysms. Patients were divided into 3 age groups based on age: <50, 50-69, and >70. Three outcomes were assessed: 1) functionality (mRS of 0-3, GOS of 4 or 5) 2) safety (lack of perioperative or postoperative complications), and 3) efficacy (obliteration of aneurysm, lack of readmission, lack of re-bleeding, or need for revision).

    Results: 14 studies met inclusion criteria (4 investigating the young age group; 5 the middle age group; 5 the elderly age group). Total cohort was 7597 patients: 265 young age, 3629 middle age, 3703 elderly age. Favorable functionality was better achieved for coiled vs clipping in the young and middle age, but not the elderly (89.1% v 80%; 82.1% v 69.6%; 59.5% v 63.7%). Favorable safety was best achieved for coiled in the young and middle age, but not the elderly (91.4% v 82.4%; 93.2% v 84.4%; 86.8% v 94.6%). Favorable efficacy was achieved for coiled in the elderly, but not the young and middle age group (91.3% v 100%; 97.2% v 98.3%; 85.4% v 82.3%).

    Conclusions: Outcomes for clipping and coiling differ across age groups in terms of their functionality, safety, and efficacy. Coiling seems to be superior in younger patient populations, whereas outcomes in the elderly remain unclear.

    Patient Care: This study better outlines the most beneficial application of the coiling or clipping of aneurysms based off of the age of the patients in question.

    Learning Objectives: 1. Clipping and coiling stand as effective treatments of un-ruptured aneurysms. 2. The efficacy of clipping and coiling vary significantly across different age populations. 3. Age in and of itself is an independent patient factor which can indicate whether clipping or coiling is the superior clinical intervention to employ.

    References: 1. Zhang QR, Zhang X, Wu Q, et al. The impact of microsurgical clipping and endovascular coiling on the outcome of cerebral aneurysms in patients over 60 years of age. J Clin Neurosci. 2012;19:1115–8. 2. Chalouhi N, Teufack S, Chandela S, Dalyai R, Tjoumakaris S, Hasan DM, Dumont AS, Gonzalez LF, Rosenwasser RH, Jabbour PM. Aneurysmal subarachnoid hemorrhage in patients under 35-years-old: a single-center experience. Clin Neurol Neurosurg. 2013;115:665–668. 3. Bekelis K, Gottlieb D, Su Y, O'Malley AJ, Labropoulos N, Goodney P, MacKenzie TA. Surgical clipping versus endovascular coiling for elderly patients presenting with subarachnoid hemorrhage. J Neurointerv Surg. 2016;8:913–918

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