Cerebral Vasospasm and Patient Outcome after Coiling or Clipping for Intracranial Aneurysmal Subarachnoid Hemorrhage

Abstract

Objective: It is still controversial whether coiling or clipping has a lower incidence of cerebral vasospasm following an aneurysmal subarachnoid hemorrhage (SAH). In this study, we compared angiographic vasospasm (AV), symptomatic vasospasm (SV), and the outcome of both procedures for ruptured cerebral aneurysms.

Methods: From 2007 to 2018, 127 patients were coiled and 127 were clipped for ruptured cerebral aneurysms. We retrospectively reviewed AV, SV, and the outcome of both procedures.

Results: The incidence of AV was 32 (25%) patients for coiling and 59 (46%) patients for clipping. SV occurred in eight (6%) patients for coiling and 19 (15%) patients for clipping, and was significantly less in the coiling group. A favorable outcome (modified Rankin scale [mRS] 0-2 on discharge) was in 71 (56%) patients for coiling and 77 (61%) patients for clipping, and there was no significant difference between the two groups.

Conclusion: The incidence of SV was significantly less in the coiling group for ruptured cerebral aneurysms. Even if SV occurred following aneurysmal SAH, early therapeutic intervention may prevent deterioration of the outcome.