Skip to main content

Advertisement

SpringerLink
Log in

Treatment outcomes of unruptured intracranial aneurysm; experience of 1231 consecutive aneurysms

  • Clinical Article - Vascular
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to review our experience with surgical clipping and endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs), with a special focus on complications.

Methods

We retrospectively analyzed clinical and radiological data from patients who underwent surgery or EVT. Surgery was performed by one neurosurgeon, and EVT was performed by two neurointerventionists according to one hybrid neurosurgeon’s decision. Adverse events included the following: (1) decline of the modified Rankin Scale (mRS) score from 1 to 2 and (2) any unexpected neurological deficit or imaging finding affecting the prognosis and/or requiring additional procedures, medication, or prolonged hospital stay.

Results

Of the 1231 UIAs in 1124 patients, 625 (50.7 %) aneurysms were treated with surgery, and 606 (49.3 %) aneurysms were treated with EVT. The overall complication rate of UIA treatment was 3.2 %. The rate of adverse events was 2.4 %, and the rates of morbidity and mortality were 0.6 and 0.2 %, respectively. The rates of adverse events, morbidity, and mortality were not significantly different between surgery and EVT. The rate of hospital use for EVT was stationary over the years of the study. Posterior circulation in surgery, large aneurysms (>15 mm) in EVT, and stent- or balloon-assisted procedures in EVT were associated with the occurrence of complications. Poor clinical outcome (mRS of 3–6) was 0.8 % at hospital discharge.

Conclusions

Both UIA treatment modalities decided by one hybrid neurosurgeon showed low complication rates and good clinical outcomes in this study. These results may serve as a point of reference for clinical decision-making for patients with UIA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

UIA:

unruptured intracranial aneurysm

EVT:

endovascular treatment

SAH:

subarachnoid hemorrhage

mRS:

modified Rankin Scale

CT:

computed tomography

MR:

magnetic resonance

MRI:

magnetic resonance imaging

ISUIA:

International Study of Unruptured Intracranial Aneurysms

MMSE:

Mini-Mental State Examination

SD:

standard deviation

OR:

odds ratio

CI:

confidence interval

References

  1. Alshekhlee A, Mehta S, Edgell RC, Vora N, Feen E, Mohammadi A, Kale SP, Cruz-Flores S (2010) Hospital mortality and complications of electively clipped or coiled unruptured intracranial aneurysm. Stroke 41:1471–1476

    Article  PubMed  Google Scholar 

  2. Barker FG 2nd, Amin-Hanjani S, Butler WE, Hoh BL, Rabinov JD, Pryor JC, Ogilvy CS, Carter BS (2004) Age-dependent differences in short-term outcome after surgical or endovascular treatment of unruptured intracranial aneurysms in the United States, 1996–2000. Neurosurgery 54:18–28, discussion 28–30

    Article  PubMed  Google Scholar 

  3. Brilstra EH, Rinkel GJ, van der Graaf Y, Sluzewski M, Groen RJ, Lo RT, Tulleken CA (2004) Quality of life after treatment of unruptured intracranial aneurysms by neurosurgical clipping or by embolisation with coils. A prospective, observational study. Cerebrovasc Dis 17:44–52

    Article  PubMed  Google Scholar 

  4. Brinjikji W, Rabinstein AA, Nasr DM, Lanzino G, Kallmes DF, Cloft HJ (2011) Better outcomes with treatment by coiling relative to clipping of unruptured intracranial aneurysms in the United States, 2001–2008. AJNR Am J Neuroradiol 32:1071–1075

    Article  CAS  PubMed  Google Scholar 

  5. Greving JP, Rinkel GJ, Buskens E, Algra A (2009) Cost-effectiveness of preventive treatment of intracranial aneurysms: new data and uncertainties. Neurology 73:258–265

    Article  PubMed  Google Scholar 

  6. Halkes PH, Wermer MJ, Rinkel GJ, Buskens E (2006) Direct costs of surgical clipping and endovascular coiling of unruptured intracranial aneurysms. Cerebrovasc Dis 22:40–45

    Article  PubMed  Google Scholar 

  7. Heller R, Calnan DR, Lanfranchi M, Madan N, Malek AM (2013) Incomplete stent apposition in Enterprise stent-mediated coiling of aneurysms: persistence over time and risk of delayed ischemic events. J Neurosurg 118:1014–1022

    Article  PubMed  Google Scholar 

  8. Hohlrieder M, Spiegel M, Hinterhoelzl J, Engelhardt K, Pfausler B, Kampfl A, Ulmer H, Waldenberger P, Mohsenipour I, Schmutzhard E (2002) Cerebral vasospasm and ischaemic infarction in clipped and coiled intracranial aneurysm patients. Eur J Neurol 9:389–399

    Article  CAS  PubMed  Google Scholar 

  9. Houkin K, Baba T, Minamida Y, Nonaka T, Koyanagi I, Iiboshi S (2009) Quantitative analysis of adverse events in neurosurgery. Neurosurgery 65:587–594, discussion 594

    Article  PubMed  Google Scholar 

  10. Igase K, Matsubara I, Igase M, Miyazaki H, Sadamoto K (2012) Initial experience in evaluating the prevalence of unruptured intracranial aneurysms detected on 3-tesla MRI. Cerebrovasc Dis 33:348–353

    Article  PubMed  Google Scholar 

  11. International Study of Unruptured Intracranial Aneurysms Investigators (1998) Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. N Engl J Med 339:1725–1733

    Article  Google Scholar 

  12. Investigators UJ, Morita A, Kirino T, Hashi K, Aoki N, Fukuhara S, Hashimoto N, Nakayama T, Sakai M, Teramoto A, Tominari S, Yoshimoto T (2012) The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 366:2474–2482

    Article  Google Scholar 

  13. Ishibashi T, Murayama Y, Saguchi T, Ebara M, Arakawa H, Irie K, Takao H, Abe T (2013) Justification of unruptured intracranial aneurysm repair: a single-center experience. AJNR Am J Neuroradiol 34:1600–1605

    Article  CAS  PubMed  Google Scholar 

  14. Ishibashi T, Murayama Y, Urashima M, Saguchi T, Ebara M, Arakawa H, Irie K, Takao H, Abe T (2009) Unruptured intracranial aneurysms: incidence of rupture and risk factors. Stroke 40:313–316

    Article  PubMed  Google Scholar 

  15. Komotar RJ, Mocco J, Solomon RA (2008) Guidelines for the surgical treatment of unruptured intracranial aneurysms: the first annual J. Lawrence pool memorial research symposium—controversies in the management of cerebral aneurysms. Neurosurgery 62:183–193, discussion 193–184

    Article  PubMed  Google Scholar 

  16. Kotowski M, Naggara O, Darsaut TE, Nolet S, Gevry G, Kouznetsov E, Raymond J (2013) Safety and occlusion rates of surgical treatment of unruptured intracranial aneurysms: a systematic review and meta-analysis of the literature from 1990 to 2011. J Neurol Neurosurg Psychiatry 84:42–48

    Article  PubMed  Google Scholar 

  17. Kwon SC, Kwon OK, Korean Unruptured Cerebral Aneurysm Coiling I (2014) Endovascular coil embolization of unruptured intracranial aneurysms: a Korean multicenter study. Acta Neurochir (Wien) 156:847–854

    Article  Google Scholar 

  18. Lad SP, Babu R, Rhee MS, Franklin RL, Ugiliweneza B, Hodes J, Nimjee SM, Zomorodi AR, Smith TP, Friedman AH, Patil CG, Boakye M (2013) Long-term economic impact of coiling vs clipping for unruptured intracranial aneurysms. Neurosurgery 72:1000–1011, discussion 1011–1003

    Article  PubMed  Google Scholar 

  19. Layton KF, Cloft HJ, Gray LA, Lewis DA, Kallmes DF (2007) Balloon-assisted coiling of intracranial aneurysms: evaluation of local thrombus formation and symptomatic thromboembolic complications. AJNR Am J Neuroradiol 28:1172–1175

    Article  CAS  PubMed  Google Scholar 

  20. Lee JY, Seo JH, Cho YD, Kang HS, Han MH (2011) Endovascular treatment of wide-neck intracranial aneurysms using a microcatheter protective technique: results and outcomes in 75 aneurysms. AJNR Am J Neuroradiol 32:917–922

    Article  CAS  PubMed  Google Scholar 

  21. Menghini VV, Brown RD Jr, Sicks JD, O’Fallon WM, Wiebers DO (1998) Incidence and prevalence of intracranial aneurysms and hemorrhage in Olmsted County, Minnesota, 1965 to 1995. Neurology 51:405–411

    Article  CAS  PubMed  Google Scholar 

  22. Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P, International Subarachnoid Aneurysm Trial Collaborative G (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:809–817

    Article  PubMed  Google Scholar 

  23. Morita A (2010) Natural course, management risks and quality of life of patients with unruptured cerebral aneurysms: Japan unruptured cerebral aneurysm study II (UCAS II). J Neurosurg 113:A414–A414

    Google Scholar 

  24. Qureshi AI, Janardhan V, Hanel RA, Lanzino G (2007) Comparison of endovascular and surgical treatments for intracranial aneurysms: an evidence-based review. Lancet Neurol 6:816–825

    Article  PubMed  Google Scholar 

  25. Qureshi AI, Suri MF, Nasar A, Kirmani JF, Divani AA, He W, Hopkins LN (2005) Trends in hospitalization and mortality for subarachnoid hemorrhage and unruptured aneurysms in the United States. Neurosurgery 57:1–8, discussion 1–8

    Article  PubMed  Google Scholar 

  26. Raaymakers TW, Rinkel GJ, Limburg M, Algra A (1998) Mortality and morbidity of surgery for unruptured intracranial aneurysms: a meta-analysis. Stroke 29:1531–1538

    Article  CAS  PubMed  Google Scholar 

  27. Rinkel GJ, Djibuti M, Algra A, van Gijn J (1998) Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 29:251–256

    Article  CAS  PubMed  Google Scholar 

  28. Schievink WI (1997) Intracranial aneurysms. N Engl J Med 336:28–40

    Article  CAS  PubMed  Google Scholar 

  29. Sonobe M, Yamazaki T, Yonekura M, Kikuchi H (2010) Small unruptured intracranial aneurysm verification study: SUAVe study, Japan. Stroke 41:1969–1977

    Article  PubMed  Google Scholar 

  30. Suzuki M, Yoneda H, Ishihara H, Shirao S, Nomura S, Koizumi H, Suehiro E, Goto H, Sadahiro H, Maruta Y, Inoue T, Oka F (2015) Adverse events after unruptured cerebral aneurysm treatment: a single-center experience with clipping/coil embolization combined units. J Stroke Cerebrovasc Dis 24:223–231

    Article  PubMed  Google Scholar 

  31. van Rooij WJ, Sluzewski M (2006) Procedural morbidity and mortality of elective coil treatment of unruptured intracranial aneurysms. AJNR Am J Neuroradiol 27:1678–1680

    PubMed  Google Scholar 

  32. White PM, Wardlaw JM (2003) Unruptured intracranial aneurysms. J Neuroradiol 30:336–350

    CAS  PubMed  Google Scholar 

  33. Yamashiro S, Nishi T, Koga K, Goto T, Kaji M, Muta D, Kuratsu J, Fujioka S (2007) Improvement of quality of life in patients surgically treated for asymptomatic unruptured intracranial aneurysms. J Neurol Neurosurg Psychiatry 78:497–500

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Conflicts of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, South Korea

    Jihye Song & Yong Sam Shin

  2. Department of Radiology, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea

    Bum-Soo Kim

Authors
  1. Jihye Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bum-Soo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yong Sam Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yong Sam Shin.

Additional information

Comment

Whether patients with incidentally discovered intracranial aneurysm should be treated, regularly observed, or resume normal life with no further investigation is highly debated. Most of us balance many factors, using scores to support our decisions, but we all lack unbiased data because of the ethical impossibility of performing “a priori randomizations.” We therefore need to compare our results and benchmark as honestly as possible. Although the study reported herein is to some extend biased by its retrospective nature and by a significant fraction of patients being lost for follow-up, the figure reported should push us all to check our own results and report. A later literature metanalysis could then most probably improve our management. We fully support the presented concept of tailored treatment using the most appropriate technique to secure the aneurysm based on a multidisciplinary team. How good is your team? Compare your team performances to others! This is what this manuscript is about.

Philippe Bijlenga

Geneva, Switzerland

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Song, J., Kim, BS. & Shin, Y.S. Treatment outcomes of unruptured intracranial aneurysm; experience of 1231 consecutive aneurysms. Acta Neurochir 157, 1303–1311 (2015). https://doi.org/10.1007/s00701-015-2460-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-015-2460-2

Keywords

Search

Navigation