Acute Endovascular Treatment Of Ruptured Intracranial Aneurysms

[Objective] To compare the use of electrically detachable coils versus surgical ligation for the endovascular management of acutely ruptured intracranial aneurysm.[Materials and Methods] A retrospective study from Apr 1994 to Apr2004 of 232 treated by endovascular or surgery with acute (<72 hours) subarachnoid hemorrhage caused by a ruptured aneurysm. 33 patients were in the endovascular group (Hunt- Hess grade â… -â…¡ [n = 23], grade â…¢ [n = 7], or grade â…£-â…¤ [n = 3] and 40 in surgical group (Hunt- Hess grade â… -â…¡ [n = 26], grade â…¢ [n = 9], or grade â…£-â…¤ [n = 5]). We compared the clinical outcome after treatment and 3-month follow up and analysed the effect of anatomic and clinical factor related to clinical outcome.[Results] Results In endovascular group 24(72.7%)cases were cured ,7(21.2%)with neurological sequelae,2(6.06%)cases died; In operative group26(65%)cases were cured ,10(25%)with neurological sequelae,4(10%)cases died. Clinical outcome (Glasgow Outcome Scale score) at 3 months was not significantly different between treatment groups in terms of intended treatment modality. Clinical outcome (Glasgow Outcome Scale score) at 3 months was close related to the Hunt - Hess scale . Significantly better primary clinical results were achieved after surgery in patients with middle cerebral artery aneurysm (n= 11, P = 0.027) and after endovascular treatment in those with anterior communicating artery aneurysm (n =11, P = .033). There is a higher complication rate in surgical group (62.5%) than that in endovascular group (27.2%) (P =0.02).[ Conclusion] Endovascular treatment of acute ruptured intracranial aneurisms can achieve similar result as with surgical treatment . In selected patients with a recently ruptured intracranial aneurysm, favorable results were achieved by using endovascular treatment. The clinical outcome at 3 months was comparable in the endovascular and surgical treatment groups but does not draw the conclusion that endovascular is superior to surgical treatment.