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E-209 Comparison of endovascular coil embolization with microsurgical clipping for the treatment of paraclinoid aneurysms
  1. S Chung,
  2. S Chang
  1. Neurosurgery, Eulji University Hospital, Daejeon, Korea, Republic of


Introduction Paraclinoid aneurysms represent approximately 5%. Recently, EVT are increasingly used because surgical approach for paraclinoid aneurysms is very hard process. Therefore, although research is rare, we compared clinical outcome for surgical clipping and EVT.

Materials and Methods A retrospective analysis of 91 patients with paraclinoid aneurysm treated with clipping or EVT during 3 years at single center. Outcome was F/U and complications were defined as new neurological deficit, intraoperative rupture, recanalization, or other required re-intervention.

Results 91 paraclinoid aneurysms were treated, including 27 with clipping and 64 with EVT. Most were discovered incidentally but 5 aneurysms were ruptured and isolated visual impairment occurred in 2. About locations, in clipping, ICA dorsal wall and ophthalmic aneurysms were 44% and in EVT, superior hypophyseal and cavernous 83%. Complete angiographic occlusion was achieved in 87%. Clipping showed in 92.5%, and EVT in 85.9%. Stent-assisted coiling showed better than coiling alone in occlusion. Good outcomes were 94.5% in clipping and 98.4% in EVT. No mortality was found. Complications observed in 25.9% after clipping, and 7.8% after EVT (p-value 0.02). Most complications improved during F/U, however, 1 in EVT and 2 in clipping were left as permanent sequalae (p-value 0.003). EVT, including coiling alone, stent-assisted coiling showed fewer intracranial hemorrhage complications, fewer NCs, and a lower unfavorable visual outcomes rate benefits over than surgical clipping. No significant difference showed in characteristics, clinical outcome, occlusion rate and reoperation. Moreover, clipping and stent-assisted coiling all showed higher occlusion rates compared with coiling alone.

Conclusion Definitely, EVT is the mainstream treatment for paraclinoid aneurysms. Surgical clipping showed a higher complication risk than EVT. Clipping might be considered to be an alternative option for paraclinoid aneurysms if EVT are for hard hurdle because many complications were temporary, and occlusion tendency of clipping was also good.

Disclosures S. Chung: None. S. Chang: None.

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