| OBJECTIVE:The influence of the treatment modalities (clipping/coiling) on the incidence of vasospasm and prognosis in aneurysmal subarachnoid hemorrhage patients is still judged controversially. We reviewed our experience over one and half years and assessed whether clipping or coiling affects patient outcome or the risk for vasospasm.METHODS:Two hundred forty-one consecutive patients were nonrandomly assigned to either surgical (n=147) or endovascular (n=94) treatment group. The following parameters were prospectively collected in a data base and retrospectively analyzed for association with four outcome measures --degree of vasospasm,symptomatic vasospasm,outcome(modified Rankin score) and in-hospital mortality: 1) Hunt and Hess grade, 2) Fisher grade, 3) aneurysm quantity and location, 4)aneurysm treatment modality, 5) admit day, 6) NICU stay length and 7) Hospital stay length. We analysed and compared retrospectively cerebral vasospasm and symptomatic cerebral vasospasm , as well as neurological outcome and in-hospital mortality of clipped and coiled patients with ruptured aneurysms,and performed multivariate regression analyses to assess the risk for the four outcome measures.RESULTS:In the clipping group there was 100% vasospam and 76.2% symptomatic vasospasm; in the coiling group there was 90.4% vasospasm and 35.1% symptomatic vasospasm; the outcome in the coiling group was better than the clipping group, and there was no significant difference in in-hospital mortality between the two groups. In the multivariate analysis, clipping, age>50 years, small aneurysm(≤10mm), Fisher grade 3,4, Hunt and Hess gradeⅢ,Ⅳ,Ⅴpredicted vasospasm. NICU stay <3 days, NICU stay 3-7 and NICU stay > 7 days are risk factors for mild, moderate, and severe cerebral vasospasm respectively. Clipping, Hunt and Hess gradeⅡ,Ⅲ,Ⅳ,Ⅴ, Fisher grade 3, 4, NICU stay 3-7 and NICU stay > 7 days predicted symptomatic vasospasm. Independent predictors of poor outcome can not be performed due to poor sample size. Predictors of in-hospital mortality were age>50, posterior circulation aneurysms, Fisher grade 4, and NICU stay > 7 days.CONCLUSION:In this retrospective nonrandomized study, compared with the clipping group, cerebral vessel vasospasm and symptomatic vasospasm was more mild, clinical outcome was better in the coiling group. In-hospital mortality was equal. Background and PurposeAdministration of oral clopidogrel plus aspirin is the most important regimen to reduce thromboembolic complications in stent-assisted coil embolization of cerebral aneurysm. However, such therapy may increase the risk of hemorrhage. The purpose of this study is to analyze the effect of two different antiplatelet regimens on hemorrhagic and thromboembolic complication rates round stent-assisted coil embolization period.MethodsRecords over a 2-year period were reviewed in a retrospective cohort study. For 49 consecutive stent-assisted coil embolization procedures over 41 patients, 9 patients received routine antiplatelet drugs (300 mg aspirin and 75mg clopidogrel) for 3 days before embolization, 32 received loading dose of antiplatelet drugs(300 mg aspirin and 300mg clopidogrel) just before induction of anesthesia. ResultsDelayed intracerebral hemorrhage(DIH) were observed more often in the routine antiplatelet group (2/9 cases, 22.2%) in comparison with the loading dose group (0/32 cases, 0%; P=0.044; Fisher exact test). The two hemorrhagic cases were both female,and occurred within 24 hours postembolization. 1 (11.1%) of 9 suffered a transient symptomatic thromboembolic events in the routine antiplatelet drug group,1 (3.1%) of 32 suffered transient ischemic attack in loading dose group (P value not significant).ConclusionOral administration of routine antiplatelet drugs for 3 days before stent-assisted coil embolization possibly increases the risk of delayed intracranial hemorrhage in yellow race, compare to loading dose group. Symptomatic thromboembolic complications have no significant difference in the two different regimens. |
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