US medical data shows coiling has better outcomes than clipping for unruptured intracranial aneurysms

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Key findings show that the proportion of unruptured aneurysms treated with coiling increased from 20% in 2001 to 63% in 2008. Fourteen per cent of patients who underwent surgical clipping were discharged to long-term facilities compared with 4.9% who underwent coiling. Clipped patients also had a higher mortality rate.

A paper published earlier this year in the American Journal of Neuroradiology by Waleed Brinjikji et al reveals that endovascular coiling is associated with decreasing periprocedural morbidity and mortality among patients treatedin the United States from 2001 to 2008 when compared to surgical clippingof unruptured intracranial aneurysms.


Brinjikji is with the Mayo Medical School, Rochester, USA.


“Endovascular therapy has increasingly become an acceptable optionfor treatment of unruptured aneurysms,” write Brinjikji et al. They set out understand  recent trends in the use of and outcomes related to coiling compared with clipping for unruptured aneurysms in the United States by evaluating the Nationwide Inpatient Sample (NIS).


The investigators identified hospitalisations for clipping or coiling of unruptured cerebral aneurysms from 2001 to 2008 by matching International Classification of Diseases (ICD) codes for the diagnosis of unruptured aneurysm with procedural codes for clipping or coiling of cerebral aneurysms. They excluded all patients with a diagnosis of subarachnoid haemorrhage and intracerebral haemorrhage. They also examined the mortality and discharge to a long-term facility for both clipping and coiling patient populations.


Results


The investigators found that the proportion of unruptured aneurysms treated with coiling increased from 20% in 2001 to 63% in 2008. They found that 14% (4184/29,918) of patients who underwent surgical clipping were discharged to long-term facilities compared with 4.9% (1655/34,125) of patients who underwent coiling (p

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