Abstract
In Japan, the treatment for ruptured aneurysms is coil embolization in approx. 40% of the cases and clipping in the other － 60%, but this treatment‒selection ratio differs greatly depending on the hospital. Here, we describe our experience treating ruptured aneurysms with the goal of determining the appropriate treatment ratio. We retrospectively analyzed the cases of the total of 107 consecutive patients with ruptured aneurysms treated at our hospital from 2015 to 2018. Aneurysms with a massive intracerebral hemorrhage (ICH) were immediately treated with clipping. Those without a massive ICH were immediately examined by digital subtraction angiography (DSA) under general anesthesia, Endovascular treatment was considered the primary option for all aneurysms without massive ICH. The choice of modality was based mainly on the overall complex architecture of the aneurysm, and not on age or SAH grade. Aneurysms determined to be suitable for either technique were treated with coiling. Clinical variables were compared between the coiling and clipping groups. Coiling was performed in 38 patients (35.5%) and clipping in 69 (64.5%). Despite the high percentage of patients with a World Federation of Neurosurgical Societies (WFNS) grade of 4 or 5 (55.1%), the percentage of favorable outcomes (modified Rankin scale, 0‒2) at 3 months after onset was high (60.7%) in the total patients. In‒hospital re‒rupture occurred in four patients (3.7%), but not during DSA. Our hospital's first‒aid system and our treatment of choice for ruptured aneurysms are acceptable because their re‒rupture rate was low and the overall treatment results were good.
