Retrospective Review Analysis of Interventional Radiologic Endovascular Coil Embolization versus Neurosurgical Clipping in Management of Intracranial Aneurysms

Abstract

Abstract Background Ruptured intracranial aneurysm and nontraumatic subarachnoid hemorrhage (SAH) are synonyms and indicators of a high-risk medical emergency. They can be treated either with endovascular approach with interventional radiological (IR) coil embolization or by neuro-surgical (NS) approach by clipping with each having their own merits and demerits and time-tested applications either requiring perioperative expectant management to prevent or curb complications of SAH or post-procedure aiming to achieve better patient outcomes. We conducted this retrospective study to analyze and gain experience from our past cases managed at tertiary care super specialty center and serve as baseline study to implement further studies and have insight for future trends in rural hospital setup in management of critical cases aimed to improve and upscale clinical outcomes in these patients. Materials and Methods Study comprised patients belonging to either of two groups, depending on the management they underwent. Analysis was done by using descriptive and inferential statistics. Results The overall study population consisted of 29.83% males and 70.18% females in this study. The overall mean age was found to be 47.33 years (standard deviation [SD] 15.68 years). In IR group, the pre- and post-procedure modified Fisher's scale (MFS) values were 53 and 50, respectively, in 31 cases, whereas the same in NS group were 43 and 53, respectively, in 23 cases. The difference change in MFS for pre- to post-procedure in IR group was small (3) and showed decreasing trend (from 53 to 50 as well as in individual Fisher grade) whereas that in NS group was big (10) and showed increasing trends (from 43 to 53 as well as in the individual Fisher grade). Conclusion Endovascular coil embolization is the surgery of choice for management of intracranial aneurysm and is minimally invasive procedure with favorable comparative outcomes on MFS than NS clipping group in our study. We recommend undertaking further prospective comparative study, incorporating our study principles and observations with inclusion of prospective clinical scale—modified Rankin's scale (MRS).