Clipping or Coiling for Ruptured Cerebral Aneurysms!

The goal of both surgery (clipping) and endovascular (coiling) treatment is to exclude the lumen of the aneurysm from circulation while preserving cerebral perfusion. Although often controversial, certain factors are used in standard practice to decide the type of treatment. These factors may include patient demographic, ability to tolerate a craniotomy (patient's comorbidities), aneurysm characteristics (eg, size, location, morphology), and available expertise. Endovascular approach is preferred in older patients, patients with severe comorbidities, and high grade SAH. It is also preferred in posterior location aneurysms, giant aneurysms, aneurysms with narrow neck or dome ratio >1.5-2, and unilobar aneurysms.

ICH, intracerebral hemorrhage; MCA, middle cerebral artery; SAH, subarachnoid hemorrhage; X, favors.

Pierot L,Wakhloo AK. Endovascular treatment of intracranial aneurysms: current status. Stroke. 2013;44(7):2046-2054.