Advertisement

Current Cardiology Reports

, 17:73 | Cite as

Treatment of Intracranial Aneurysms: Clipping Versus Coiling

  • Ann Liu
  • Judy Huang
Stroke (D Wang, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Stroke

Abstract

Intracranial aneurysms (IAs) have an estimated incidence of up to 10 % and can lead to serious morbidity and mortality. Because of this, the natural history of IAs has been studied extensively, with rupture rates ranging from 0.5 to 7 %, depending on aneurysm characteristics. The spectrum of presentation of IAs ranges from incidental detection to devastating subarachnoid hemorrhage. Although the gold standard imaging technique is intra-arterial digital subtraction angiography, other modalities such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are being increasingly used for screening and treatment planning. Management of these patients depends upon a number of factors including aneurysmal, patient, institutional, and operator factors. The ultimate goal of treating patients with IAs is complete and permanent occlusion of the aneurysm sac in order to eliminate future hemorrhagic risk, while preserving or restoring the patient’s neurological function. The most common treatment approaches include microsurgical clipping and endovascular coiling, and multiple studies have compared these two techniques. To date, three large prospective, randomized studies have been done: a study from Finland, International Subarachnoid Aneurysm Trial (ISAT), and the Barrow Ruptured Aneurysm Trial (BRAT). Despite differences in methodology, the results were similar: in patients undergoing coiling, although rates of rebleeding and retreatment are higher, the overall rate of poor outcomes at 12 months was significantly lower. As minimally invasive procedures and devices continue to be refined, endovascular strategies are likely to increase in popularity. However, as long-term outcome studies become available, it is increasingly apparent that they are complementary treatment strategies, with patient selection of critical importance.

Keywords

Intracranial aneurysm Clipping Coiling Coiling versus clipping Endovascular Microsurgical Subarachnoid hemorrhage 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

Ann Liu and Judy Huang declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Unruptured intracranial aneurysms--risk of rupture and risks of surgical intervention. International study of unruptured intracranial aneurysms investigators. N Engl J Med. 1998;339:1725–33.CrossRefGoogle Scholar
  2. 2.
    Rinkel GJ. Natural history, epidemiology and screening of unruptured intracranial aneurysms. Rev Neurol (Paris). 2008;164:781–6.CrossRefGoogle Scholar
  3. 3.
    Vlak MH, Algra A, Brandenburg R, Rinkel GJ. Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: a systematic review and meta-analysis. Lancet Neurol. 2011;10:626–36.CrossRefPubMedGoogle Scholar
  4. 4.
    Linn FH, Rinkel GJ, Algra A, van Gijn J. Incidence of subarachnoid hemorrhage: role of region, year, and rate of computed tomography: a meta-analysis. Stroke. 1996;27:625–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Vernooij MW, Ikram MA, Tanghe HL, Vincent AJ, Hofman A, Krestin GP, et al. Incidental findings on brain MRI in the general population. N Engl J Med. 2007;357:1821–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Morita A, Fujiwara S, Hashi K, Ohtsu H, Kirino T. Risk of rupture associated with intact cerebral aneurysms in the Japanese population: a systematic review of the literature from Japan. J Neurosurg. 2005;102:601–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Krischek B, Inoue I. The genetics of intracranial aneurysms. J Hum Genet. 2006;51:587–94.CrossRefPubMedGoogle Scholar
  8. 8.
    Caranci F, Briganti F, Cirillo L, Leonardi M, Muto M. Epidemiology and genetics of intracranial aneurysms. Eur J Radiol. 2013;82:1598–605.CrossRefPubMedGoogle Scholar
  9. 9.
    Krex D, Schackert HK, Schackert G. Genesis of cerebral aneurysms—an update. Acta Neurochir (Wien). 2001;143:429–48. discussion 448–429.CrossRefGoogle Scholar
  10. 10.
    Stehbens WE. Aneurysms and anatomical variation of cerebral arteries. Arch Pathol. 1963;75:45–64.PubMedGoogle Scholar
  11. 11.
    Alg VS, Sofat R, Houlden H, Werring DJ. Genetic risk factors for intracranial aneurysms: a meta-analysis in more than 116,000 individuals. Neurology. 2013;80:2154–65.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture. J Neurosurg. 2000;93:379–87.CrossRefPubMedGoogle Scholar
  13. 13.
    Wiebers DO, Whisnant JP, O'Fallon WM. The natural history of unruptured intracranial aneurysms. N Engl J Med. 1981;304:696–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Wiebers DO, Whisnant JP, Sundt Jr TM, O’Fallon WM. The significance of unruptured intracranial saccular aneurysms. J Neurosurg. 1987;66:23–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Tsutsumi K, Ueki K, Morita A, Kirino T. Risk of rupture from incidental cerebral aneurysms. J Neurosurg. 2000;93:550–3.CrossRefPubMedGoogle Scholar
  16. 16.
    Wermer MJ, van der Schaaf IC, Algra A, Rinkel GJ. Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics: an updated meta-analysis. Stroke. 2007;38:1404–10.CrossRefPubMedGoogle Scholar
  17. 17.•
    Juvela S, Poussa K, Lehto H, Porras M. Natural history of unruptured intracranial aneurysms: a long-term follow-up study. Stroke. 2013;44:2414–21. This study describes the natural history of unruptured intracranial aneurysms with a median follow-up of 21 years.CrossRefPubMedGoogle Scholar
  18. 18.
    Wiebers DO, Whisnant JP, Huston 3rd J, Meissner I, Brown Jr RD, Piepgras DG, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362:103–10.CrossRefPubMedGoogle Scholar
  19. 19.
    Lee EJ, Lee HJ, Hyun MK, Choi JE, Kim JH, Lee NR, et al. Rupture rate for patients with untreated unruptured intracranial aneurysms in South Korea during 2006–2009. J Neurosurg. 2012;117:53–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Sonobe M, Yamazaki T, Yonekura M, Kikuchi H. Small unruptured intracranial aneurysm verification study: SUAVe study. Japan Stroke. 2010;41:1969–77.CrossRefPubMedGoogle Scholar
  21. 21.
    Bederson JB, Connolly Jr ES, Batjer HH, Dacey RG, Dion JE, Diringer MN, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 2009;40:994–1025.CrossRefPubMedGoogle Scholar
  22. 22.
    Brisman JL, Song JK, Newell DW. Cerebral aneurysms. N Engl J Med. 2006;355:928–39.CrossRefPubMedGoogle Scholar
  23. 23.
    Keedy A. An overview of intracranial aneurysms. Mcgill J Med. 2006;9:141–6.PubMedCentralPubMedGoogle Scholar
  24. 24.
    Wardlaw JM, White PM. The detection and management of unruptured intracranial aneurysms. Brain. 2000;123(Pt 2):205–21.CrossRefPubMedGoogle Scholar
  25. 25.
    Anxionnat R, Bracard S, Ducrocq X, Trousset Y, Launay L, Kerrien E, et al. Intracranial aneurysms: clinical value of 3D digital subtraction angiography in the therapeutic decision and endovascular treatment. Radiology. 2001;218:799–808.CrossRefPubMedGoogle Scholar
  26. 26.
    Tanoue S, Kiyosue H, Kenai H, Nakamura T, Yamashita M, Mori H. Three-dimensional reconstructed images after rotational angiography in the evaluation of intracranial aneurysms: surgical correlation. Neurosurgery. 2000;47:866–71.CrossRefPubMedGoogle Scholar
  27. 27.
    Warnock NG, Gandhi MR, Bergvall U, Powell T. Complications of intraarterial digital subtraction angiography in patients investigated for cerebral vascular disease. Br J Radiol. 1993;66:855–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Raza SM, Papadimitriou K, Gandhi D, Radvany M, Olivi A, Huang J. Intra-arterial intraoperative computed tomography angiography guided navigation: a new technique for localization of vascular pathology. Neurosurgery. 2012;71:ons240–52. discussion ons252.CrossRefPubMedGoogle Scholar
  29. 29.
    Leffers AM, Wagner A. Neurologic complications of cerebral angiography. A retrospective study of complication rate and patient risk factors. Acta Radiol. 2000;41:204–10.CrossRefPubMedGoogle Scholar
  30. 30.
    Waugh JR, Sacharias N. Arteriographic complications in the DSA era. Radiology. 1992;182:243–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Connors 3rd JJ, Sacks D, Furlan AJ, Selman WR, Russell EJ, Stieg PE, et al. Training, competency, and credentialing standards for diagnostic cervicocerebral angiography, carotid stenting, and cerebrovascular intervention: a joint statement from the American Academy of Neurology, the American Association of Neurological Surgeons, the American Society of Interventional and Therapeutic Neuroradiology, the American Society of Neuroradiology, the Congress of Neurological Surgeons, the AANS/CNS Cerebrovascular Section, and the Society of Interventional Radiology. J Vasc Interv Radiol. 2009;20:S292–301.CrossRefPubMedGoogle Scholar
  32. 32.
    Dion JE, Gates PC, Fox AJ, Barnett HJ, Blom RJ. Clinical events following neuroangiography: a prospective study. Stroke. 1987;18:997–1004.CrossRefPubMedGoogle Scholar
  33. 33.
    Heiserman JE, Dean BL, Hodak JA, Flom RA, Bird CR, Drayer BP, et al. Neurologic complications of cerebral angiography. AJNR Am J Neuroradiol. 1994;15:1401–7. discussion 1408–1411.PubMedGoogle Scholar
  34. 34.
    Hoh BL, Cheung AC, Rabinov JD, Pryor JC, Carter BS, Ogilvy CS. Results of a prospective protocol of computed tomographic angiography in place of catheter angiography as the only diagnostic and pretreatment planning study for cerebral aneurysms by a combined neurovascular team. Neurosurgery. 2004;54:1329–40. discussion 1340–1322.CrossRefPubMedGoogle Scholar
  35. 35.
    Chappell ET, Moure FC, Good MC. Comparison of computed tomographic angiography with digital subtraction angiography in the diagnosis of cerebral aneurysms: a meta-analysis. Neurosurgery. 2003;52:624–31. discussion 630–621.CrossRefPubMedGoogle Scholar
  36. 36.
    Dammert S, Krings T, Moller-Hartmann W, Ueffing E, Hans FJ, Willmes K, et al. Detection of intracranial aneurysms with multislice CT: comparison with conventional angiography. Neuroradiology. 2004;46:427–34.CrossRefPubMedGoogle Scholar
  37. 37.
    Harrison MJ, Johnson BA, Gardner GM, Welling BG. Preliminary results on the management of unruptured intracranial aneurysms with magnetic resonance angiography and computed tomographic angiography. Neurosurgery. 1997;40:947–55. discussion 955–947.CrossRefPubMedGoogle Scholar
  38. 38.
    Kangasniemi M, Makela T, Koskinen S, Porras M, Poussa K, Hernesniemi J. Detection of intracranial aneurysms with two-dimensional and three-dimensional multislice helical computed tomographic angiography. Neurosurgery. 2004;54:336–40. discussion 340–331.CrossRefPubMedGoogle Scholar
  39. 39.
    White PM, Teasdale EM, Wardlaw JM, Easton V. Intracranial aneurysms: CT angiography and MR angiography for detection prospective blinded comparison in a large patient cohort. Radiology. 2001;219:739–49.CrossRefPubMedGoogle Scholar
  40. 40.
    Pradilla G, Wicks RT, Hadelsberg U, Gailloud P, Coon AL, Huang J, et al. Accuracy of computed tomography angiography in the diagnosis of intracranial aneurysms. World Neurosurg. 2013;80:845–52.CrossRefPubMedGoogle Scholar
  41. 41.
    Menke J, Larsen J, Kallenberg K. Diagnosing cerebral aneurysms by computed tomographic angiography: meta-analysis. Ann Neurol. 2011;69:646–54.CrossRefPubMedGoogle Scholar
  42. 42.
    van Gelder JM. Computed tomographic angiography for detecting cerebral aneurysms: implications of aneurysm size distribution for the sensitivity, specificity, and likelihood ratios. Neurosurgery. 2003;53:597–605. discussion 605–596.CrossRefPubMedGoogle Scholar
  43. 43.
    Weng HH, Jao SY, Yang CY, Tsai YH. Meta-analysis on diagnostic accuracy of MR angiography in the follow-up of residual intracranial aneurysms treated with Guglielmi detachable coils. Interv Neuroradiol. 2008;14 Suppl 2:53–63.PubMedCentralPubMedGoogle Scholar
  44. 44.
    Stock KW, Radue EW, Jacob AL, Bao XS, Steinbrich W. Intracranial arteries: prospective blinded comparative study of MR angiography and DSA in 50 patients. Radiology. 1995;195:451–6.CrossRefPubMedGoogle Scholar
  45. 45.
    Deutschmann HA, Augustin M, Simbrunner J, Unger B, Schoellnast H, Fritz GA, et al. Diagnostic accuracy of 3D time-of-flight MR angiography compared with digital subtraction angiography for follow-up of coiled intracranial aneurysms: influence of aneurysm size. AJNR Am J Neuroradiol. 2007;28:628–34.PubMedGoogle Scholar
  46. 46.
    Okahara M, Kiyosue H, Yamashita M, Nagatomi H, Hata H, Saginoya T, et al. Diagnostic accuracy of magnetic resonance angiography for cerebral aneurysms in correlation with 3D-digital subtraction angiographic images: a study of 133 aneurysms. Stroke. 2002;33:1803–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Schwab KE, Gailloud P, Wyse G, Tamargo RJ. Limitations of magnetic resonance imaging and magnetic resonance angiography in the diagnosis of intracranial aneurysms. Neurosurgery. 2008;63:29–34. discussion 34–25.CrossRefPubMedGoogle Scholar
  48. 48.
    Schuierer G, Huk WJ, Laub G. Magnetic resonance angiography of intracranial aneurysms: comparison with intra-arterial digital subtraction angiography. Neuroradiology. 1992;35:50–4.CrossRefPubMedGoogle Scholar
  49. 49.
    Tampieri D, Leblanc R, Oleszek J, Pokrupa R, Melancon D. Three-dimensional computed tomographic angiography of cerebral aneurysms. Neurosurgery. 1995;36:749–54. discussion 754–745.CrossRefPubMedGoogle Scholar
  50. 50.
    Gasparotti R, Liserre R. Intracranial aneurysms. Eur Radiol. 2005;15:441–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Pearl MS, Torok C, Katz Z, Messina SA, Blasco J, Tamargo RJ, et al. Diagnostic quality and accuracy of low dose 3D-DSA protocols in the evaluation of intracranial aneurysms. J Neurointerv Surg. 2015;7:386–90.CrossRefPubMedGoogle Scholar
  52. 52.
    Dandy WE. Intracranial aneurysm of the internal carotid artery: cured by operation. Ann Surg. 1938;107:654–9.CrossRefPubMedCentralPubMedGoogle Scholar
  53. 53.
    Chiang VL, Gailloud P, Murphy KJ, Rigamonti D, Tamargo RJ. Routine intraoperative angiography during aneurysm surgery. J Neurosurg. 2002;96:988–92.CrossRefPubMedGoogle Scholar
  54. 54.
    Caplan JM, Papadimitriou K, Yang W, Colby GP, Coon AL, Olivi A, et al. The minipterional craniotomy for anterior circulation aneurysms: initial experience with 72 patients. Neurosurgery. 2014;10 Suppl 2:200–6. discussion 206–207.CrossRefPubMedGoogle Scholar
  55. 55.
    Caplan JM, Sankey E, Yang W, Radvany MG, Colby GP, Coon AL, et al. Impact of indocyanine green videoangiography on rate of clip adjustments following intraoperative angiography. Neurosurgery. 2014;75:437–43. disucssion 444.CrossRefPubMedGoogle Scholar
  56. 56.
    Raja PV, Huang J, Germanwala AV, Gailloud P, Murphy KP, Tamargo RJ. Microsurgical clipping and endovascular coiling of intracranial aneurysms: a critical review of the literature. Neurosurgery. 2008;62:1187–202. discussion 1202–1183.CrossRefPubMedGoogle Scholar
  57. 57.
    Nayar VV F, K. Day, A.L.: Management of Unruptured Intracranial Aneurysms., in A Q-H (ed): Schmidek & Sweet Operative Neurosurgical Techniques; Indications, Methods, and Results. . Philadelphia, PA: Elsevier, 2012, Vol 1, pp 812–822.Google Scholar
  58. 58.
    Molyneux A, Kerr R. International Subarachnoid Aneurysm Trial Collaborative G, Stratton I, Sandercock P, Clarke M, et al.: International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial. J Stroke Cerebrovasc Dis. 2002;11:304–14.CrossRefPubMedGoogle Scholar
  59. 59.
    Raftopoulos C. Is surgical clipping becoming underused? Acta Neurochir (Wien). 2005;147:117–23. discussion 123–114.CrossRefGoogle Scholar
  60. 60.
    Mcdougall CG. Endovascular coiling of intracranial aneurysms. In: Winn HR, editor. Youmans neurological surgery. 6th ed. Philadelphia: Elsevier Saunders; 2011.Google Scholar
  61. 61.
    Vanninen R, Koivisto T, Saari T, Hernesniemi J, Vapalahti M. Ruptured intracranial aneurysms: acute endovascular treatment with electrolytically detachable coils—a prospective randomized study. Radiology. 1999;211:325–36.CrossRefPubMedGoogle Scholar
  62. 62.
    Koivisto T, Vanninen R, Hurskainen H, Saari T, Hernesniemi J, Vapalahti M. Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms, a prospective randomized study. Stroke. 2000;31:2369–77.CrossRefPubMedGoogle Scholar
  63. 63.
    Koivisto T, Vanninen E, Vanninen R, Kuikka J, Hernesniemi J, Vapalahti M. Cerebral perfusion before and after endovascular or surgical treatment of acutely ruptured cerebral aneurysms: a 1-year prospective follow-up study. Neurosurgery. 2002;51:312–25. discussion 325–316.PubMedGoogle Scholar
  64. 64.
    Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005;366:809–17.CrossRefPubMedGoogle Scholar
  65. 65.••
    Molyneux AJ, Birks J, Clarke A, Sneade M, Kerr RS. The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT). Lancet. 2015;385:691–7. This study describes the long-term follow-up results of the International Subarachnoid Aneurysm Trial.CrossRefPubMedCentralPubMedGoogle Scholar
  66. 66.••
    McDougall CG, Spetzler RF, Zabramski JM, Partovi S, Hills NK, Nakaji P, et al. The Barrow Ruptured Aneurysm Trial. J Neurosurg. 2012;116:135–44. They found that the outcomes at 1 year were improved in patients who underwent coiling as compared to patients who underwent clipping. These results were similar to those in the ISAT study.CrossRefPubMedGoogle Scholar
  67. 67.••
    Spetzler RF, McDougall CG, Albuquerque FC, Zabramski JM, Hills NK, Partovi S, et al. The Barrow ruptured aneurysm trial: 3-year results. J Neurosurg. 2013;119:146–57. This study is a follow-up report on the results of BRAT. The authors found that outcomes of coiled patients remained better than that of clipped patients, although patients who underwent clipping had a higher degree of obliteration with a lower rate of recurrence and retreatment.CrossRefPubMedGoogle Scholar
  68. 68.
    Hernesniemi J, Koivisto T. Comments on the impact of the International Subarachnoid Aneurysm Treatment Trial (ISAT) on neurosurgical practice. Acta Neurochir (Wien). 2004;146:203–8.CrossRefGoogle Scholar
  69. 69.
    Sellar R, Whittle I. The ISAT trial. Lancet. 2003;361:432–3. author reply 433.CrossRefPubMedGoogle Scholar
  70. 70.
    Ogilvy CS. Neurosurgical clipping versus endovascular coiling of patients with ruptured intracranial aneurysms. Stroke. 2003;34:2540–2.CrossRefPubMedGoogle Scholar
  71. 71.
    Harbaugh RE. Commentary. Surg Neurol. 2003;59:165–7.CrossRefGoogle Scholar
  72. 72.
    Campi A, Ramzi N, Molyneux AJ, Summers PE, Kerr RS, Sneade M, et al. Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke. 2007;38:1538–44.CrossRefPubMedGoogle Scholar
  73. 73.
    Molyneux AJ, Kerr RSC, Birks J, Ramzi N, Yarnold J, Sneade M, et al. Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol. 2009;8:427–33.Google Scholar
  74. 74.••
    Lanzino G, Murad MH, d’Urso PI, Rabinstein AA. Coil embolization versus clipping for ruptured intracranial aneurysms: a meta-analysis of prospective controlled published studies. AJNR Am J Neuroradiol. 2013;34:1764–8. This study is a meta-analysis of the three prospective, randomized studies comparing clipping and coiling (ISAT, BRAT, and Vanninen et al.) Overall, the rate of poor outcomes at 1 year was significantly lower in patients undergoing coiling.CrossRefPubMedGoogle Scholar
  75. 75.
    Piotin M, Gailloud P, Bidaut L, Mandai S, Muster M, Moret J, et al. CT angiography, MR angiography and rotational digital subtraction angiography for volumetric assessment of intracranial aneurysms. An experimental study. Neuroradiology. 2003;45:404–9.CrossRefPubMedGoogle Scholar
  76. 76.•
    Raymond J, Kotowski M, Darsaut TE, Molyneux AJ, Kerr RS. Ruptured aneurysms and the International Subarachnoid Aneurysm Trial (ISAT): what is known and what remains to be questioned. Neurochirurgie. 2012;58:103–14. This paper reviews the criticisms of ISAT and attempts to identify aspects of ISAT that could have been improved.CrossRefPubMedGoogle Scholar
  77. 77.
    Fiorella D, Kelly ME, Moskowitz S, Masaryk TJ. Delayed symptomatic coil migration after initially successful balloon-assisted aneurysm coiling: technical case report. Neurosurgery. 2009;64:E391–2. discussion E392.CrossRefPubMedGoogle Scholar
  78. 78.
    Brilstra EH, Rinkel GJ, van der Graaf Y, van Rooij WJ, Algra A. Treatment of intracranial aneurysms by embolization with coils: a systematic review. Stroke. 1999;30:470–6.CrossRefPubMedGoogle Scholar
  79. 79.
    Lozier AP, Connolly Jr ES, Lavine SD, Solomon RA. Guglielmi detachable coil embolization of posterior circulation aneurysms: a systematic review of the literature. Stroke. 2002;33:2509–18.CrossRefPubMedGoogle Scholar
  80. 80.
    Lusseveld E, Brilstra EH, Nijssen PC, van Rooij WJ, Sluzewski M, Tulleken CA, et al. Endovascular coiling versus neurosurgical clipping in patients with a ruptured basilar tip aneurysm. J Neurol Neurosurg Psychiatry. 2002;73:591–3.CrossRefPubMedCentralPubMedGoogle Scholar
  81. 81.
    Pandey AS, Koebbe C, Rosenwasser RH, Veznedaroglu E. Endovascular coil embolization of ruptured and unruptured posterior circulation aneurysms: review of a 10-year experience. Neurosurgery. 2007;60:626–36. discussion 636–627.CrossRefPubMedGoogle Scholar
  82. 82.
    Karamanakos PN, Koivisto T, Vanninen R, Khallaf M, Ronkainen A, Parviainen I, et al. The impact of endovascular management on the outcome of aneurysmal subarachnoid hemorrhage in the elderly in eastern Finland. Acta Neurochir (Wien). 2010;152:1493–502.CrossRefGoogle Scholar
  83. 83.
    Cai Y, Spelle L, Wang H, Piotin M, Mounayer C, Vanzin JR, et al. Endovascular treatment of intracranial aneurysms in the elderly: single-center experience in 63 consecutive patients. Neurosurgery. 2005;57:1096–102. discussion 1096–1102.CrossRefPubMedGoogle Scholar
  84. 84.
    Brinjikji W, Rabinstein AA, Lanzino G, Kallmes DF, Cloft HJ. Effect of age on outcomes of treatment of unruptured cerebral aneurysms: a study of the National Inpatient Sample 2001–2008. Stroke. 2011;42:1320–4.CrossRefPubMedGoogle Scholar
  85. 85.
    Ryttlefors M, Enblad P, Kerr RS, Molyneux AJ. International subarachnoid aneurysm trial of neurosurgical clipping versus endovascular coiling: subgroup analysis of 278 elderly patients. Stroke. 2008;39:2720–6.CrossRefPubMedGoogle Scholar
  86. 86.
    Bracard S, Lebedinsky A, Anxionnat R, Neto JM, Audibert G, Long Y, et al. Endovascular treatment of Hunt and Hess grade IV and V aneuryms. AJNR Am J Neuroradiol. 2002;23:953–7.PubMedGoogle Scholar
  87. 87.
    Proust F, Gerardin E, Derrey S, Lesveque S, Ramos S, Langlois O, et al. Interdisciplinary treatment of ruptured cerebral aneurysms in elderly patients. J Neurosurg. 2010;112:1200–7.CrossRefPubMedGoogle Scholar
  88. 88.
    Ohno K, Arai T, Isotani E, Nariai T, Hirakawa K. Ischaemic complication following obliteration of unruptured cerebral aneurysms with atherosclerotic or calcified neck. Acta Neurochir (Wien). 1999;141:699–705. discussion 705–696.CrossRefGoogle Scholar
  89. 89.
    Asari S. Surgical management of the unruptured cerebral aneurysm accompanied by ischemic cerebrovascular disease. Clin Neurol Neurosurg. 1992;94:119–25.CrossRefPubMedGoogle Scholar
  90. 90.
    Brinjikji W, Lanzino G, Cloft HJ, Rabinstein A, Kallmes DF. Endovascular treatment of very small (3 mm or smaller) intracranial aneurysms: report of a consecutive series and a meta-analysis. Stroke. 2010;41:116–21.CrossRefPubMedGoogle Scholar
  91. 91.
    Rinne J, Hernesniemi J, Niskanen M, Vapalahti M. Analysis of 561 patients with 690 middle cerebral artery aneurysms: anatomic and clinical features as correlated to management outcome. Neurosurgery. 1996;38:2–11.CrossRefPubMedGoogle Scholar
  92. 92.
    Zipfel GJ, Dacey RG. Update on the management of unruptured intracranial aneurysms. Neurosurg Focus. 2004;17, E2.CrossRefPubMedGoogle Scholar
  93. 93.
    Lehecka M, Dashti R, Lehto H, Kivisaari R, Niemela M, Hernesniemi J. Distal anterior cerebral artery aneurysms. Acta Neurochir Suppl. 2010;107:15–26.CrossRefPubMedGoogle Scholar
  94. 94.
    Mitchell P, Kerr R, Mendelow AD, Molyneux A. Could late rebleeding overturn the superiority of cranial aneurysm coil embolization over clip ligation seen in the International Subarachnoid Aneurysm Trial? J Neurosurg. 2008;108:437–42.CrossRefPubMedGoogle Scholar
  95. 95.
    Johnston SC. Effect of endovascular services and hospital volume on cerebral aneurysm treatment outcomes. Stroke. 2000;31:111–7.CrossRefPubMedGoogle Scholar
  96. 96.
    Berman MF, Solomon RA, Mayer SA, Johnston SC, Yung PP. Impact of hospital-related factors on outcome after treatment of cerebral aneurysms. Stroke. 2003;34:2200–7.CrossRefPubMedGoogle Scholar
  97. 97.
    Johnston SC, Dudley RA, Gress DR, Ono L. Surgical and endovascular treatment of unruptured cerebral aneurysms at university hospitals. Neurology. 1999;52:1799.CrossRefPubMedGoogle Scholar
  98. 98.
    Johnston SC, Wilson CB, Halbach VV, Higashida RT, Dowd CF, McDermott MW, et al. Endovascular and surgical treatment of unruptured cerebral aneurysms: comparison of risks. Ann Neurol. 2000;48:11–9.CrossRefPubMedGoogle Scholar
  99. 99.
    Hoh BL, Rabinov JD, Pryor JC, Carter BS, Barker 2nd FG. In-hospital morbidity and mortality after endovascular treatment of unruptured intracranial aneurysms in the United States, 1996–2000: effect of hospital and physician volume. AJNR Am J Neuroradiol. 2003;24:1409–20.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of NeurosurgeryWake Forest School of MedicineWinston-SalemUSA
  2. 2.Department of NeurosurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of NeurosurgeryJohns Hopkins HospitalBaltimoreUSA

Personalised recommendations