Abstract
The purpose of this study is to find the better form of early treatment for patients with aneurysmal subarachnoid haemorrhage (SAH). Since endovascular coil embolization was introduced as the early treatment of SAH, 325 SAH patients underwent angiography and 280 patients were treated at an acute stage using either surgical clip application or endovascular coil embolization (1997 onwards, Group B). We retrospectively analyzed the therapeutic decision-making process in these 280 cases and compared its outcome with that of 299 consecutive cases treated before the introduction of coil embolization (1990〜1996, Group A). Of the 280 cases, 177 cases (63%) were treated with surgical clip application and 103 cases (37%) with endovascular coil embolization. In the patients with poor SAH grades (Hunt & Kosnik [H & K] grade 4〜5), high age (≥70 yr), posterior circulation aneurysm and multiple aneurysms, endovascular coil embolization was preferentially chosen. The percentage of the patients with occluded aneurysm at the acute stage significantly increased from 54% (Group B) to 78% (Group A), from 42% to 76% and from 50% to 81% in the cases of H & K Grade 4〜5, high age and basilar bifurcation aneurysm, respectively. As a result, the percentage of the cases with favourable outcome (Glasgow Outcome Scale score 1 or 2 at discharge) significantly increased. Early rebleeding occurred in two cases that had been treated with endovascular coil embolization. Although endovascular coil embolization has the advantage of being less invasive to the brain, its treatment completeness is considered inferior to surgical intervention. We should choose treatment strategy for aneurysm on a case-by-case basis, depending on factors including the neurological conditions, patient age and general conditions as well as the aneurysm location, size and configuration.
