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Clipping Versus Coiling for Ruptured MCA Aneurysms Associated with Intracerebral Hematoma Requiring Surgical Evacuation

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Abstract

Background

Ruptured middle cerebral artery aneurysm (MCAa) can lead to intracerebral hematoma, and surgical evacuation can be performed in these cases. MCAa can be treated by clipping or before by endovascular therapy (EVT). Our objective was to compare the impact on the functional outcome of MCAa in patients with intracerebral hematoma requiring evacuation.

Methods

This is a multicenter, retrospective, cohort study with nine French neurosurgical units from January 1, 2013, to December 31, 2020. All participants were adult patients who required evacuation of an intracerebral hematoma. We looked for risk factors for poor outcomes by comparing the baseline characteristics and treatments performed by using the 6-month modified Rankin scale score. Poor outcomes were defined by an modified Rankin scale score of 3–6.

Results

A total of 162 patients were included. A total of 129 (79.6%) patients were treated by microsurgery, and 33 (20.4%) patients were treated by EVT. In multivariate analysis, factors associated with poor outcomes included hematoma volume, realization of a decompressive craniectomy, occurrence of procedure-related symptomatic cerebral ischemia, occurrence of delayed cerebral ischemia, and EVT. In the propensity score matching analysis (n = 33 per group), poor outcomes were observed in 30% of the patients in the clipping group versus 76% in the EVT group (P < 0.001). These differences may have been related to a longer delay between hospital admission and hematoma evacuation in the EVT group.

Conclusions

In the specific subgroup of ruptured MCAa with intracerebral hematoma that requires surgical evacuation, clipping with concomitant hematoma evacuation could provide better functional outcomes than EVT followed by surgical evacuation.

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Abbreviations

DC:

Decompressive craniectomy

EVT:

Endovascular therapy

IA:

Intracranial aneurysm

ICH:

Intracerebral hematoma

ISAT:

International Subarachnoid Aneurysm Trial

IVH:

Intraventricular hemorrhage

MCAa:

Middle cerebral artery aneurysm

mRs:

Modified Rankin scale

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Funding

The authors have no funding to disclose.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital of Caen, Caen, France

    Thomas Metayer, Evelyne Emery, Arthur Leclerc, Alin Borha & Thomas Gaberel

  2. Physiopathology and Imaging of Neurological Disorders, Institut Blood and Brain @ Caen-Normandie, Institut National de la Santé et de la Recherche Médicale, University of Caen Normandy, Cyceron, France

    Thomas Metayer, Denis Vivien, Evelyne Emery, Alin Borha & Thomas Gaberel

  3. Department of Neurosurgery, Hospices Civils de Lyon, Lyon, France

    Chloe Dumot & Isabelle Pelissou-Guyotat

  4. Department of Neurosurgery, University Hospital of Angers, Angers, France

    Florian Bernard

  5. Department of Neurosurgery, University Hospital of Rennes, Rennes, France

    Pierre-Jean Le Reste

  6. Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France

    Anne-Laure Bernat

  7. Department of Neurosurgery, University Hospital of Strasbourg, Strasbourg, France

    Helene Cebula, Charles-Henry Mallereau & Francois Proust

  8. Department of Neurosurgery, University Hospital of Brest, Brest, France

    Charles Peltier & Elsa Magro

  9. Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France

    Caroline le Guerinel & Sorin Aldea

  10. Department of Neuroradiology, Rothschild Foundation Hospital, Paris, France

    Michel Piotin

  11. Department of Neuroradiology, University Hospital of Rouen, Rouen, France

    Vianney Gillard & Stephane Derrey

  12. Department of Neuroradiology, University Hospital of Caen, Caen, France

    Charlotte Barbier

  13. Biostatistics and Clinical Research Unit, University Hospital of Caen Normandy, Caen, France

    Lawrence Nadin & Anais R. Briant

  14. Service de Neurochirurgie, CHU de Caen, Avenue de la Côte de Nacre, 14000, Caen, France

    Thomas Metayer

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  1. Thomas Metayer
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Contributions

TG designed the study; TM, CD, FB, PJLR, ALN, HB, MCH, CP, VG, AL, SA, and AB collected the data; LN and ARB analyzed the data; CLG, MP, EE, EM, FP, IPG, DV, SD, CB, TM, and TG wrote and corrected the article. All authors approved this final manuscript.

Corresponding author

Correspondence to Thomas Metayer.

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Conflicts of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this article.

Ethical approval and informed consent

This cohort study has been reported in accordance with the STROBE statements (www.strobe-statement.org). The study was reviewed and approved by the institutional review board of neurosurgery (n°IRB00011687 College de Neurochirurgie institutional review board #1 2022/12).

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Metayer, T., Dumot, C., Bernard, F. et al. Clipping Versus Coiling for Ruptured MCA Aneurysms Associated with Intracerebral Hematoma Requiring Surgical Evacuation. Neurocrit Care 39, 162–171 (2023). https://doi.org/10.1007/s12028-023-01702-8

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  • DOI: https://doi.org/10.1007/s12028-023-01702-8

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