Treatment Approaches for Aneursym Repair
The most common complication after initial aSAH is rebleeding, which occurs in up to 38.5% of patients within the first 12 hours (Connolly et al., 2012; Diringer et al., 2011; Naidech et al., 2005; Sacco et al., 2009). Rebleeding after aSAH is associated with worsened outcomes (Cha et al., 2010), particularly 2-12 hours after the initial bleed (Diringer et al., 2011). A key risk factor for rebleed is prolonged time to definitive aneurysm treatment (Naidech et al., 2005; Connolly et al., 2010). Therefore, early treatment is preferred with either a surgical or endovascular approach. .
The surgical approach for aneurysm treatment includes a craniotomy with placement of a surgical clip to obliterate the aneurysm (AANN, 2010). Surgical clipping may be preferred for wide neck or berry aneurysms. In contrast, an endovascular approach that includes placement of platinum and/or platinum/fiber coils via arterial access may be considered (AANN, 2010). Endovascular coiling was first established in 1991, and involves threading various diameter coils through endovascular catheters to the aneurysm. The coils are typically electrolytically released from a guidewire when positioned withing the body of the aneurysm. The volume and surface area of the coils slow and obstruct the flow of blood through the body of the aneurysm, allowing thrombus formation within the aneurysm site.
Among patients eligible for either clipping or coiling, those who receive coiling typically have lower rates of death and disability, epilepsy, and cognitive decline (Cha et al., 2010; Connolly et al., 2012; Risselada et al., 2010). However, coiling can be associated with an increased risk of rebleeding and inadequate obliteration of the aneurysm (Molyneux et al., 2005; Connolly et al., 2012). While coiling remains a preferred option due to its non-invasive nature and improved outcomes, it may not be appropriate for all patients.