Study Compares Brain Aneurysm Treatments

Two techniques - coiling and clipping of brain aneurysms - produce similar, effective results over the long term, concludes a U.S. study of 1,010 patients at eight institutions.

"While it is true that some aneurysms can only be treated with clipping and some only with coiling, most patients can be treated with either method," study leader Dr. S. Claiborne Johnston, a neurologist at the University of California, San Francisco, said in a prepared statement.

Clipping the aneurysm involves invasive brain surgery. In coiling, a small catheter is placed into the groin and threaded up to the brain. A small platinum wire is released into the aneurysm to clot it off from the inside.

A previous study had suggested that coiling was superior to surgical clipping one year after treatment. There's a lack of data on long-term outcomes, however.

"This leaves the physician and the patient in the awkward position to decide which is best," Johnston said. "Without good data on long-term results, the choice is difficult and may be based on purely anecdotal evidence or the preference of the physician," he added.

Of the patients in this study, 711 were treated with clipping and 299 treated with coiling. Maximum length of follow-up was 9.6 years for clipped patients and 8.9 years for coiled patients. The patients treated with coiling were older, more likely to have smaller aneurysms, and less likely to have middle cerebral artery aneurysms.

One of the patients treated with coiling suffered a re-rupture of the aneurysm 14 months later. Re-treatment for aneurysm was more common in patients treated with coiling, but major complications were rare during re-treatment.

"Because it is less invasive, coiling may be the first choice of treatment for many patients, but there are a number of issues to be considered. With coiling, a patient should have follow-up, including another angiogram. Also, with coiling, there is the possibility of having to have another coiling procedure. With clipping, it's over and done," Johnston said.

The findings appear in the June issue of Stroke.

- Robert Preidt

SOURCE: University of California, San Francisco, news release, May 26, 2006