Outcome After Clipping and Coiling for Aneurysmal Subarachnoid Hemorrhage in Clinical Practice in Europe, USA, and Australia
Abstract BACKGROUND Within randomized clinical trials (RCTs), coiling of the ruptured aneurysm to prevent rebleeding results in better outcomes than clipping in patients with aneurysmal subarachnoid hemorrhage (aSAH). OBJECTIVE To study the association of coiling and clipping with outcome after aSAH...
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| Published in | Neurosurgery Vol. 84; no. 5; pp. 1019 - 1027 |
|---|---|
| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Oxford University Press
01.05.2019
Copyright by the Congress of Neurological Surgeons Wolters Kluwer Health, Inc |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0148-396X 1524-4040 1524-4040 |
| DOI | 10.1093/neuros/nyy223 |
Cover
| Abstract | Abstract
BACKGROUND
Within randomized clinical trials (RCTs), coiling of the ruptured aneurysm to prevent rebleeding results in better outcomes than clipping in patients with aneurysmal subarachnoid hemorrhage (aSAH).
OBJECTIVE
To study the association of coiling and clipping with outcome after aSAH in daily clinical practice.
METHODS
In this controlled, nonrandomized study, we compared outcomes after endovascular coiling and neurosurgical clipping of ruptured intracranial aneurysms in an administrative dataset of 7658 aSAH patients (22 tertiary care hospitals from Europe, USA, Australia; 2007-2013). Because the results contradicted those of the randomized trials, findings were further explored in a large clinical dataset from 2 European centers (2006-2016) of 1501 patients.
RESULTS
In the administrative dataset, the crude 14-d case-fatality rate was 6.4% (95% confidence interval [CI] 5.6%-7.2%) after clipping and 8.2% (95% CI 7.4%-9.1%) after coiling. After adjustment for age, sex, and comorbidity/severity, the odds ratio (OR) for 14-d case-fatality after coiling compared to clipping was 1.32 (95% CI 1.10-1.58). In the clinical dataset crude 14-d case fatality rate was 5.7% (95% CI 4.2%-7.8%) for clipping and 9.0% (95% CI 7.3%-11.2%) for coiling. In multivariable logistic regression analysis, the OR for 14-d case-fatality after coiling compared to clipping was 1.7 (95% CI 1.1–2.7), for 90-d case-fatality 1.28 (95% CI 0.91–1.82) and for 90-d poor functional outcome 0.78 (95% CI 0.6–1.01).
CONCLUSION
In clinical practice, coiling after aSAH is associated with higher 14-d case-fatality than clipping and nonsuperior outcomes at 90 d. Both options need to be considered in aSAH patients. Further studies should address the reasons for the discrepancy between current data and those from the RCTs. |
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| AbstractList | Within randomized clinical trials (RCTs), coiling of the ruptured aneurysm to prevent rebleeding results in better outcomes than clipping in patients with aneurysmal subarachnoid hemorrhage (aSAH).BACKGROUNDWithin randomized clinical trials (RCTs), coiling of the ruptured aneurysm to prevent rebleeding results in better outcomes than clipping in patients with aneurysmal subarachnoid hemorrhage (aSAH).To study the association of coiling and clipping with outcome after aSAH in daily clinical practice.OBJECTIVETo study the association of coiling and clipping with outcome after aSAH in daily clinical practice.In this controlled, nonrandomized study, we compared outcomes after endovascular coiling and neurosurgical clipping of ruptured intracranial aneurysms in an administrative dataset of 7658 aSAH patients (22 tertiary care hospitals from Europe, USA, Australia; 2007-2013). Because the results contradicted those of the randomized trials, findings were further explored in a large clinical dataset from 2 European centers (2006-2016) of 1501 patients.METHODSIn this controlled, nonrandomized study, we compared outcomes after endovascular coiling and neurosurgical clipping of ruptured intracranial aneurysms in an administrative dataset of 7658 aSAH patients (22 tertiary care hospitals from Europe, USA, Australia; 2007-2013). Because the results contradicted those of the randomized trials, findings were further explored in a large clinical dataset from 2 European centers (2006-2016) of 1501 patients.In the administrative dataset, the crude 14-d case-fatality rate was 6.4% (95% confidence interval [CI] 5.6%-7.2%) after clipping and 8.2% (95% CI 7.4%-9.1%) after coiling. After adjustment for age, sex, and comorbidity/severity, the odds ratio (OR) for 14-d case-fatality after coiling compared to clipping was 1.32 (95% CI 1.10-1.58). In the clinical dataset crude 14-d case fatality rate was 5.7% (95% CI 4.2%-7.8%) for clipping and 9.0% (95% CI 7.3%-11.2%) for coiling. In multivariable logistic regression analysis, the OR for 14-d case-fatality after coiling compared to clipping was 1.7 (95% CI 1.1-2.7), for 90-d case-fatality 1.28 (95% CI 0.91-1.82) and for 90-d poor functional outcome 0.78 (95% CI 0.6-1.01).RESULTSIn the administrative dataset, the crude 14-d case-fatality rate was 6.4% (95% confidence interval [CI] 5.6%-7.2%) after clipping and 8.2% (95% CI 7.4%-9.1%) after coiling. After adjustment for age, sex, and comorbidity/severity, the odds ratio (OR) for 14-d case-fatality after coiling compared to clipping was 1.32 (95% CI 1.10-1.58). In the clinical dataset crude 14-d case fatality rate was 5.7% (95% CI 4.2%-7.8%) for clipping and 9.0% (95% CI 7.3%-11.2%) for coiling. In multivariable logistic regression analysis, the OR for 14-d case-fatality after coiling compared to clipping was 1.7 (95% CI 1.1-2.7), for 90-d case-fatality 1.28 (95% CI 0.91-1.82) and for 90-d poor functional outcome 0.78 (95% CI 0.6-1.01).In clinical practice, coiling after aSAH is associated with higher 14-d case-fatality than clipping and nonsuperior outcomes at 90 d. Both options need to be considered in aSAH patients. Further studies should address the reasons for the discrepancy between current data and those from the RCTs.CONCLUSIONIn clinical practice, coiling after aSAH is associated with higher 14-d case-fatality than clipping and nonsuperior outcomes at 90 d. Both options need to be considered in aSAH patients. Further studies should address the reasons for the discrepancy between current data and those from the RCTs. BACKGROUND: Within randomized clinical trials (RCTs), coiling of the ruptured aneurysm to prevent rebleeding results in better outcomes than clipping in patients with aneurysmal subarachnoid hemorrhage (aSAH). OBJECTIVE: To study the association of coiling and clipping with outcome after aSAH in daily clinical practice. METHODS: In this controlled, nonrandomized study, we compared outcomes after endovascular coiling and neurosurgical clipping of ruptured intracranial aneurysms in an administrative dataset of 7658 aSAH patients (22 tertiary care hospitals from Europe, USA, Australia; 2007-2013). Because the results contradicted those of the randomized trials, findings were further explored in a large clinical dataset from 2 European centers (2006-2016) of 1501 patients. RESULTS: In the administrative dataset, the crude 14-d case-fatality rate was 6.4% (95% confidence interval [CI] 5.6%-7.2%) after clipping and 8.2% (95% CI 7.4%-9.1%) after coiling. After adjustment for age, sex, and comorbidity/severity, the odds ratio (OR) for 14-d case-fatality after coiling compared to clipping was 1.32 (95% C11.10-1.58). In the clinical dataset crude 14-d case fatality rate was 5.7% (95% CI 4.2%-7.8%) for clipping and 9.0% (95% CI 7.3%-11.2%) for coiling. In multivariable logistic regression analysis, the OR for 14-d case-fatality after coiling compared to clipping was 1.7 (95% C11.1-2.7), for 90-d case-fatality 1.28 (95% CI 0.91-1.82) and for 90-d poor functional outcome 0.78 (95% CI 0.6-1.01). CONCLUSION: In clinical practice, coiling after aSAH is associated with higher 14-d case-fatality than clipping and nonsuperior outcomes at 90 d. Both options need to be considered in aSAH patients. Further studies should address the reasons for the discrepancy between current data and those from the RCTs. KEY WORDS: Aneurysm, Intracranial aneurysm, Subarachnoid hemorrhage, Outcomes research, Epidemiology, Endovascular, Clipping DOI: 10.1093/neuros/nyy223 BACKGROUND Within randomized clinical trials (RCTs), coiling of the ruptured aneurysm to prevent rebleeding results in better outcomes than clipping in patients with aneurysmal subarachnoid hemorrhage (aSAH). OBJECTIVE To study the association of coiling and clipping with outcome after aSAH in daily clinical practice. METHODS In this controlled, nonrandomized study, we compared outcomes after endovascular coiling and neurosurgical clipping of ruptured intracranial aneurysms in an administrative dataset of 7658 aSAH patients (22 tertiary care hospitals from Europe, USA, Australia; 2007-2013). Because the results contradicted those of the randomized trials, findings were further explored in a large clinical dataset from 2 European centers (2006-2016) of 1501 patients. RESULTS In the administrative dataset, the crude 14-d case-fatality rate was 6.4% (95% confidence interval [CI] 5.6%-7.2%) after clipping and 8.2% (95% CI 7.4%-9.1%) after coiling. After adjustment for age, sex, and comorbidity/severity, the odds ratio (OR) for 14-d case-fatality after coiling compared to clipping was 1.32 (95% CI 1.10-1.58). In the clinical dataset crude 14-d case fatality rate was 5.7% (95% CI 4.2%-7.8%) for clipping and 9.0% (95% CI 7.3%-11.2%) for coiling. In multivariable logistic regression analysis, the OR for 14-d case-fatality after coiling compared to clipping was 1.7 (95% CI 1.1–2.7), for 90-d case-fatality 1.28 (95% CI 0.91–1.82) and for 90-d poor functional outcome 0.78 (95% CI 0.6–1.01). CONCLUSION In clinical practice, coiling after aSAH is associated with higher 14-d case-fatality than clipping and nonsuperior outcomes at 90 d. Both options need to be considered in aSAH patients. Further studies should address the reasons for the discrepancy between current data and those from the RCTs. Within randomized clinical trials (RCTs), coiling of the ruptured aneurysm to prevent rebleeding results in better outcomes than clipping in patients with aneurysmal subarachnoid hemorrhage (aSAH). To study the association of coiling and clipping with outcome after aSAH in daily clinical practice. In this controlled, nonrandomized study, we compared outcomes after endovascular coiling and neurosurgical clipping of ruptured intracranial aneurysms in an administrative dataset of 7658 aSAH patients (22 tertiary care hospitals from Europe, USA, Australia; 2007-2013). Because the results contradicted those of the randomized trials, findings were further explored in a large clinical dataset from 2 European centers (2006-2016) of 1501 patients. In the administrative dataset, the crude 14-d case-fatality rate was 6.4% (95% confidence interval [CI] 5.6%-7.2%) after clipping and 8.2% (95% CI 7.4%-9.1%) after coiling. After adjustment for age, sex, and comorbidity/severity, the odds ratio (OR) for 14-d case-fatality after coiling compared to clipping was 1.32 (95% CI 1.10-1.58). In the clinical dataset crude 14-d case fatality rate was 5.7% (95% CI 4.2%-7.8%) for clipping and 9.0% (95% CI 7.3%-11.2%) for coiling. In multivariable logistic regression analysis, the OR for 14-d case-fatality after coiling compared to clipping was 1.7 (95% CI 1.1-2.7), for 90-d case-fatality 1.28 (95% CI 0.91-1.82) and for 90-d poor functional outcome 0.78 (95% CI 0.6-1.01). In clinical practice, coiling after aSAH is associated with higher 14-d case-fatality than clipping and nonsuperior outcomes at 90 d. Both options need to be considered in aSAH patients. Further studies should address the reasons for the discrepancy between current data and those from the RCTs. Abstract BACKGROUND Within randomized clinical trials (RCTs), coiling of the ruptured aneurysm to prevent rebleeding results in better outcomes than clipping in patients with aneurysmal subarachnoid hemorrhage (aSAH). OBJECTIVE To study the association of coiling and clipping with outcome after aSAH in daily clinical practice. METHODS In this controlled, nonrandomized study, we compared outcomes after endovascular coiling and neurosurgical clipping of ruptured intracranial aneurysms in an administrative dataset of 7658 aSAH patients (22 tertiary care hospitals from Europe, USA, Australia; 2007-2013). Because the results contradicted those of the randomized trials, findings were further explored in a large clinical dataset from 2 European centers (2006-2016) of 1501 patients. RESULTS In the administrative dataset, the crude 14-d case-fatality rate was 6.4% (95% confidence interval [CI] 5.6%-7.2%) after clipping and 8.2% (95% CI 7.4%-9.1%) after coiling. After adjustment for age, sex, and comorbidity/severity, the odds ratio (OR) for 14-d case-fatality after coiling compared to clipping was 1.32 (95% CI 1.10-1.58). In the clinical dataset crude 14-d case fatality rate was 5.7% (95% CI 4.2%-7.8%) for clipping and 9.0% (95% CI 7.3%-11.2%) for coiling. In multivariable logistic regression analysis, the OR for 14-d case-fatality after coiling compared to clipping was 1.7 (95% CI 1.1–2.7), for 90-d case-fatality 1.28 (95% CI 0.91–1.82) and for 90-d poor functional outcome 0.78 (95% CI 0.6–1.01). CONCLUSION In clinical practice, coiling after aSAH is associated with higher 14-d case-fatality than clipping and nonsuperior outcomes at 90 d. Both options need to be considered in aSAH patients. Further studies should address the reasons for the discrepancy between current data and those from the RCTs. |
| Audience | Academic |
| Author | Hemmen, Thomas M Jääskeläinen, Juha E Alberts, Mark Meretoja, Atte Sillekens, Tomas Vergouwen, Mervyn D I Lee, Jin-Moo Turner, Ellie Bragan Lindgren, Antti Koivisto, Timo Rinkel, Gabriel J E Lemmens, Robin |
| AuthorAffiliation | Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland Dr Foster Ltd and Global Comparators Department of Neurology, Helsinki University Hospital, Helsinki, Finland Department of Medicine at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia Department of Neurology, and the Hope Center for Neurological disorders, Washington University School of Medicine, St. Louis, Missouri Department of Neurosciences, University of California, San Diego, California Department of Neurology, Hartford Hospital, Hartford, Connecticut KU Leuven – University of Leuven, Department of Neurosciences, Experimental Neurology, Leuven Institute for Neuroscience and Disease (LIND), Leuven, Belgium VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium University Hospitals Leuven, Department of Neurology, Leuven, Belgium Unive |
| AuthorAffiliation_xml | – name: Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland Dr Foster Ltd and Global Comparators Department of Neurology, Helsinki University Hospital, Helsinki, Finland Department of Medicine at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia Department of Neurology, and the Hope Center for Neurological disorders, Washington University School of Medicine, St. Louis, Missouri Department of Neurosciences, University of California, San Diego, California Department of Neurology, Hartford Hospital, Hartford, Connecticut KU Leuven – University of Leuven, Department of Neurosciences, Experimental Neurology, Leuven Institute for Neuroscience and Disease (LIND), Leuven, Belgium VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium University Hospitals Leuven, Department of Neurology, Leuven, Belgium University Hospitals Leuven. Netherlands University Medical Center Utrecht. United Kingdom Royal United Hospital Bath NHS Trust Royal Berkshire NHS Foundation Trust Sheffield Teaching Hospitals NHS Foundation Trust. United States Barnes-Jewish Hospital Jillian Newman, Huntsville Hospital Massachusetts General Hospital UC San Diego Health System UTSouthwestern Health system. Norway Finland and Australia Helsinki University Hospital and Royal Melbourne Hospital – name: 12 University Hospitals Leuven. Netherlands – name: 15 Royal Berkshire NHS Foundation Trust – name: 18 Jillian Newman, Huntsville Hospital – name: 14 Royal United Hospital Bath NHS Trust – name: 19 Massachusetts General Hospital – name: 4 Department of Neurology, Helsinki University Hospital, Helsinki, Finland – name: 2 Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland – name: 1 Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands – name: 13 University Medical Center Utrecht. United Kingdom – name: 7 Department of Neurosciences, University of California, San Diego, California – name: 16 Sheffield Teaching Hospitals NHS Foundation Trust. United States – name: 8 Department of Neurology, Hartford Hospital, Hartford, Connecticut – name: 10 VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium – name: 9 KU Leuven – University of Leuven, Department of Neurosciences, Experimental Neurology, Leuven Institute for Neuroscience and Disease (LIND), Leuven, Belgium – name: 17 Barnes-Jewish Hospital – name: 6 Department of Neurology, and the Hope Center for Neurological disorders, Washington University School of Medicine, St. Louis, Missouri – name: 3 Dr Foster Ltd and Global Comparators – name: 5 Department of Medicine at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia – name: 21 UTSouthwestern Health system. Norway – name: 11 University Hospitals Leuven, Department of Neurology, Leuven, Belgium – name: 23 Helsinki University Hospital and Royal Melbourne Hospital – name: 20 UC San Diego Health System – name: 22 Finland and Australia |
| Author_xml | – sequence: 1 givenname: Antti orcidid: 0000-0002-1264-7667 surname: Lindgren fullname: Lindgren, Antti email: antti.lindgren@kuh.fi organization: Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands – sequence: 2 givenname: Ellie Bragan surname: Turner fullname: Turner, Ellie Bragan organization: Dr Foster Ltd and Global Comparators – sequence: 3 givenname: Tomas surname: Sillekens fullname: Sillekens, Tomas organization: Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands – sequence: 4 givenname: Atte surname: Meretoja fullname: Meretoja, Atte organization: Department of Neurology, Helsinki University Hospital, Helsinki, Finland – sequence: 5 givenname: Jin-Moo surname: Lee fullname: Lee, Jin-Moo organization: Department of Neurology, and the Hope Center for Neurological disorders, Washington University School of Medicine, St. Louis, Missouri – sequence: 6 givenname: Thomas M surname: Hemmen fullname: Hemmen, Thomas M organization: Department of Neurosciences, University of California, San Diego, California – sequence: 7 givenname: Timo surname: Koivisto fullname: Koivisto, Timo organization: Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland – sequence: 8 givenname: Mark surname: Alberts fullname: Alberts, Mark organization: Department of Neurology, Hartford Hospital, Hartford, Connecticut – sequence: 9 givenname: Robin surname: Lemmens fullname: Lemmens, Robin organization: KU Leuven – University of Leuven, Department of Neurosciences, Experimental Neurology, Leuven Institute for Neuroscience and Disease (LIND), Leuven, Belgium – sequence: 10 givenname: Juha E surname: Jääskeläinen fullname: Jääskeläinen, Juha E organization: Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland – sequence: 11 givenname: Mervyn D I surname: Vergouwen fullname: Vergouwen, Mervyn D I organization: Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands – sequence: 12 givenname: Gabriel J E surname: Rinkel fullname: Rinkel, Gabriel J E organization: Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29846713$$D View this record in MEDLINE/PubMed |
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| Copyright | Copyright © 2018 by the Congress of Neurological Surgeons 2018 Copyright © by the Congress of Neurological Surgeons Copyright © 2018 by the Congress of Neurological Surgeons. COPYRIGHT 2019 Oxford University Press Copyright © 2018 by the Congress of Neurological Surgeons |
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| CorporateAuthor | Dr Foster Unit at Imperial College London Stroke GOAL Group, Dr Foster Global Comparators Project, Dr Foster Ltd |
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| Keywords | Subarachnoid hemorrhage Intracranial aneurysm Endovascular Aneurysm Clipping Outcomes research Epidemiology |
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A study of the overall outcome publication-title: Br J Neurosurg doi: 10.1080/02688690500389781 – volume: 88 start-page: 327 year: 2016 ident: bib5-20231011 article-title: Trends in the Management and Hospital Outcome of Spontaneous Subarachnoid Hemorrhage in the Post-International Subarachnoid Aneurysm Trial Era in Greece: Analysis of 719 Patients During a 13-Year Period publication-title: World Neurosurg doi: 10.1016/j.wneu.2015.11.103 – volume: 42 start-page: 90 issue: 2 year: 2014 ident: bib10-20231011 article-title: Treatment of aneurysmal subarachnoid haemorrhage in germany: A nationwide analysis of the years 2005-2009 publication-title: Neuroepidemiology doi: 10.1159/000355843 – reference: 30892614 - Neurosurgery. 2019 Jun 1;84(6):E446 – reference: 30892647 - Neurosurgery. 2019 Jun 1;84(6):E447 – reference: 29878164 - Neurosurgery. 2019 May 1;84(5):E264-E265 |
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BACKGROUND
Within randomized clinical trials (RCTs), coiling of the ruptured aneurysm to prevent rebleeding results in better outcomes than clipping... Within randomized clinical trials (RCTs), coiling of the ruptured aneurysm to prevent rebleeding results in better outcomes than clipping in patients with... BACKGROUND: Within randomized clinical trials (RCTs), coiling of the ruptured aneurysm to prevent rebleeding results in better outcomes than clipping in... BACKGROUND Within randomized clinical trials (RCTs), coiling of the ruptured aneurysm to prevent rebleeding results in better outcomes than clipping in... |
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| SubjectTerms | Adult Aneurysm Aneurysm, Ruptured - mortality Aneurysm, Ruptured - surgery Aneurysms Australia Belgium Blood Vessel Prosthesis Cerebral aneurysm Clinical medicine Clinical trials Comparative analysis Datasets Endovascular Procedures - instrumentation Endovascular Procedures - methods Endovascular Procedures - mortality Epidemiology Europe Fatalities Female Finland Hemorrhage Hospitals Humans Intracranial Aneurysm - mortality Intracranial Aneurysm - surgery Male Medical research Middle Aged Netherlands Neurosurgery Neurosurgical Procedures - instrumentation Neurosurgical Procedures - methods Neurosurgical Procedures - mortality Patient outcomes Regression analysis Research—Human—Clinical Studies Stroke Subarachnoid hemorrhage Subarachnoid Hemorrhage - mortality Subarachnoid Hemorrhage - surgery Surgical Instruments Treatment Outcome United Kingdom United States |
| Title | Outcome After Clipping and Coiling for Aneurysmal Subarachnoid Hemorrhage in Clinical Practice in Europe, USA, and Australia |
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