Which treatment of cerebral aneurysms is more popular — Coil Embolization or Surgical Clipping?
There are two types of surgical procedures available for those suffering with unruptured aneurysms – coil embolization and surgical clipping. While any surgery is invasive and contains risk, patients are bound to ask: Which procedure is best for me?
The answer isn’t clear-cut, since the type of surgery needed is dependent upon numerous factors. However, the latest statistics suggest there is a preferred method.
The study, published in the May issue of the Journal of NeuroInterventional Surgery (JNIS), found the majority of unruptured aneurysms in the United States are now treated with coil embolization (also referred to as endovascular coiling). The authors, led by Dr. Ning Lin of Brigham and Women’s Hospital’s Department of Neurosurgery in Boston, researched approximately 35,000 cases between 1998 and 2007 where patients were discharged from hospitals with a diagnosis of ruptured or unruptured cerebral aneurysm.
Percentage of Cases where Surgical Clipping was performed
|Ruptured Aneurysms||Unruptured Aneurysms|
|Pre-2002||90.7% of cases||79.4% of cases|
|Post-2002||57.1% of cases||38.3% of cases|
According to the study’s authors:
[P]atients with unruptured aneurysms treated by coiling have fewer adverse events, lower mortality, shorter hospital stay and smaller hospital charge.
The study did note that while surgical clipping had been the common approach for treatment of most ruptured aneurysms, it has given way to coiling in recent years. It also looked further into the race, gender and socioeconomics of those who underwent these procedures, and showed that “delivery of care for patients in all gender and racial subgroups has become more uniform over time”:
[T]his study examined practice patterns across race and gender and investigated the changes of these factors over time, both of which had not been previously performed for patients with an aneurysm in these data. … The delivery of care for patients in all gender and racial subgroups has become more uniform over time.
It was also noted that coil embolization, which was formerly only done at “specialized university-based hospitals” that traditionally had more funding and experienced surgeons, had become more widespread into smaller regional hospitals, allowing for more patients to take advantage of the procedure.