Endovascular therapy versus surgical clipping for basilar artery bifurcation aneurysm.

Abstract

Microsurgical exposure of basilar bifurcation aneurysms poses technical challenges that do not affect coiling procedures. Endovascular coiling techniques for basilar bifurcation aneurysms, in contrast to surgical clipping techniques, have similar published complication rates as coiling for aneurysms at other sites.1 Consequently, there has been relatively widespread advocacy for endovascular coiling as the primary therapeutic option for many posterior circulation aneurysms, as evidenced by posterior circulation aneurysms representing only 2.7% of the cases in the ISAT trial (which considered only those ruptured aneurysms considered equally suited to either endovascular or surgical techniques).2 The scant published comparative data currently available does provide evidence suggesting improved outcome with endovascular coiling over surgical clipping for basilar bifurcation aneurysms considered suitable for either technique.3