4610
document
Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms . A prospective randomized study . BACKGROUND AND PURPOSE This prospective study was conducted to compare the outcomes of surgical clipping and endovascular treatment in acute ( < 72 hours ) aneurysmal subarachnoid hemorrhage ( SAH ) . METHODS One hundred nine consecutive patients were randomly assigned to either surgical ( n=57 ) or endovascular ( n=52 ) treatment . Clinical and neuropsychological outcome was assessed at 3 and 12 months after treatment ; MRI of the brain was performed at 12 months . Follow-up angiography was scheduled after clipping and 3 and 12 months after endovascular treatment . RESULTS One year postoperatively , 43/41 ( surgical/endovascular ) patients had good or moderate recovery , 5/4 had severe disability or were in a vegetative state , and 9/7 had died ( NS ) according to intention to treat . Patients with good clinical recovery did not differ in their neuropsychological test scores . Symptomatic vasospasm ( OR 2.47 ; 95 % CI 1.45 to 4.19 ; P < 0.001 ) , poorer Hunt and Hess grade ( OR 2.50 ; 95 % CI 1.31 to 4.75 ; P=0.005 ) , need for permanent shunt ( OR 8.90 ; 95 % CI 1.80 to 44.15 ; P=0.008 ) , and larger size of the aneurysm ( OR 1 . 22 ; 95 % CI 1.02 to 1.45 ; P=0.032 ) independently predicted worsened clinical outcome regardless of the treatment modality . In MRI , superficial brain retraction deficits ( P < 0.001 ) and ischemic lesions in the territory of the ruptured aneurysm ( P=0.025 ) were more frequent in the surgical group . Kaplan-Meier analysis ( mean+/-SD follow-up 39+/-18 months ) revealed equal survival in both treatment groups . No late rebleedings have occurred . CONCLUSIONS One-year clinical and neuropsychological outcomes seem comparable after early surgical and endovascular treatment of ruptured intracranial aneurysms . The long-term efficacy of endovascular treatment in preventing rebleeding remains open .
4611
Intervention_Surgical
surgical treatment
4612
Intervention_Surgical
surgical clipping and endovascular treatment
4613
Intervention_Surgical
surgical
4614
Intervention_Pharmacological
endovascular
4615
Intervention_Physical
Follow-up angiography
4616
Intervention_Physical
MRI
4617
Outcome_Physical
Outcomes of early endovascular versus surgical treatment
4618
Outcome_Physical
cerebral aneurysms .
4619
Outcome_Other
recovery
4620
Outcome_Physical
severe disability or were in a vegetative state
4621
Outcome_Mortality
died
4622
Outcome_Other
recovery
4623
Outcome_Mental
neuropsychological test scores
4624
Outcome_Physical
. Symptomatic vasospasm
4625
Outcome_Physical
Hunt and Hess grade
4626
Outcome_Physical
need for permanent shunt
4627
Outcome_Physical
larger size of the aneurysm
4628
Outcome_Physical
clinical outcome
4629
Outcome_Physical
superficial brain retraction deficits
4630
Outcome_Physical
ischemic lesions
4631
Outcome_Physical
ruptured aneurysm
4632
Outcome_Mortality
survival
4633
Outcome_Physical
late rebleedings
4634
Outcome_Physical
rebleeding
4635
Participant_Sample-size
One hundred nine