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Clipping or Coiling for Ruptured Cerebral Aneurysms!

Updated: Oct 7, 2022


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.

Favors Endovascular Treatment

Favors Surgical Treatment

Age

>70 Years

Younger Age

Severe Comorbidities

X

SAH Grade

High

Low

Presence of ICH

No

Yes

Location

Posterior circulation, proximal

MCA, pericallosal, distal

Neck

Narrow

Wide

Morphology

Unilobar

Unilobar or fusiform (with arterial branches exiting from aneurysm sac)

Size

>25 mm

25 mm or less

Dome ratio (width/neck)

>1.5-2

<1.5-2

Vascular Anatomy

Nontortuous, nonatherosclerotic proximal vessels

Tortuous or atherosclerotic proximal vessels

Atherosclerotic calcifications of aneurysm or perianeurysmal parent artery

X

Vasospasm

X

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.




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