Article Figures & Data
Figures
- Fig 1.
Coiling AOR scattergram showing 19 prospective and retrospective studies. The average AOR was 8.8% (95% CI 7.6%–10.1%). Numbers correlate with study number given in Table 2.
- Fig 2.
Coiling AORs versus time by median study date. Coiling, a relatively new procedure, demonstrates decreasing AORs between 1993 and 2000.
- Fig 3.
Clipping AORs versus time by median study date. Clipping AORs increased between 1984 and 1999 after publication of larger, prospective multicenter studies.
- Fig 4.
Clipping AOR scattergram showing 30 prospective and retrospective studies. The average AOR was 17.8% (95% CI 17.2%–18.6%). Numbers correlate with study number given in Table 3.
Tables
Clipping Coiling Studies Retrospective single center 21 10 Prospective single center 1 5 Multicenter or community-based 8 4 Total 30 19 Patient baseline information Mean age (y) 57.0 53.1 Aneurysm size UIA No.* % UIA No.‡ % UIA No. % Small 1399 35.7 297 36.1 1696 35.8 Medium 1394 35.6 236 28.7 1630 34.4 Large 898 22.9 219 26.6 1117 23.6 Giant 224 5.7 70 8.5 294 6.2 Total 3915 822 4737 Aneurysm site UIA No.† % UIA No.§ % UIA No. % Cavernous carotid artery 102 2.4 99 10.3 201 3.8 ICA and Ophthalmic 1542 36.1 269 27.9 1811 34.6 ACom, ACA, and pericollosal 676 15.8 173 18.0 849 16.2 MCA 1340 31.3 117 12.1 1457 27.8 PCom 183 4.3 71 7.4 245 4.9 Vertebrobasilar system 239 5.6 81 8.4 320 6.1 Basilar tip 194 4.5 153 15.9 347 6.6 Total 4276 963 5239 Note.—ICA indicates internal carotid artery; ACom, anterior communicating artery; ACA, anterior cerebral artery; PCom, posteror communicating artery. UIA nos. were based on the following references:
* , 11, 14, 18–24;
† , 3, 11, 14, 18–21, 23, 24, 25–27;
‡ , 3, 5, 7, 28–31;
§ , 3, 7, 28, 32.
Study No. Reference Study Type Mean Age Patient No. Definition of Morbidity AOR (%) AOE (No.) 95% CI (%) Mortality (%) 1 Cognard et al, 1998 (33) PS 46 58 GOS ≤ 3 1.7 1 0.7–4.4 1.7 2 Collice et al, 1998 (8) RS 57 10 Severe disability/death 30.0 3 4.7–17.9 0.0 3 Debrun et al, 1998 (32) RS 49 89 GOS ≤ 3 10.1 9 7.4–13.7 7.9 4 Eskridge and Song, 1998 (4) PM 52 67 Presented morbidity/mortality data 14.0 9 9.8–18.1 12.0 5 Keuther et al, 1998 (34) RS Not reported 41 Death/dependent status 19.5 8 14.1–26.4 9.8 6 Leber et al, 1998 (35) RS 53 45 Morbidity/mortality data 11.5 6 9.0–19.2 Not reported 7 Bavinzski et al, 1999 (5) RS 47 11 Neurologic deficit, unable to work, needed assistance 18.0 2 9.4–32.7 9.0 8 Johnston et al, 1999 (36) RM 55 255 In-hospital mortality, D/C to nursing home/rehabilitation hospital 10.6 27 8.8–12.7 0.4 9 Lot et al, 1999 (37) PS 47 83 Moderate to severe deficit, death 4.8 4 3.0–7.7 Not reported 10 Murayama et al, 1999 (28) RS 51 115 Morbidity/mortality data 8.3 10 6.5–11.7 Not reported 11 Johnston, 2000 (38) RS 57 62 ≥2 change in mRS 8.1 5 5.3–12.2 1.6 12 Johnston et al, 2001 (2) RM 56 287 In hospital death or D/C to nursing home/rehabilitation hospital 9.7 28 8.2–11.6 0.5 13 Qureshi et al, 2001 (6) RS Not reported 80 Author report 2.0 2 1.3–4.9 0.0 14 Roy et al, 2001 (30) PS 51 116 mRS ≥3 0.9 1 0.3–2.2 0.0 15 Goddard et al, 2002 (29) RS 56 62 Moderate to severe deficit, death 5.5 3 2.8–8.3 0.0 median 16 Ng et al, 2002 (39) RS Not reported 58 GOS ≤3 1.7 1 0.7–4.4 1.7 17 Wanke et al, 2002 (31) PS 48 39 GOS not “good recovery” 4.8 2 2.6–10.0 0.0 18 Raftopoulos et al, 2003 (7) PS 49 38 mRS ≥3 0.0 0 0.0–2.5 0.0 19 Wiebers et al, 2003 (3) PM 54 451 mRS change of ≥3 and/or impaired cognition 9.3 38 8.0–10.8 2.0 Note.—RS indicates retrospective single center; RM, retrospective multicenter; PM, prospective multicenter; AOR, adverse outcome rate; AOE, patient adverse outcome event.
Study No. Reference Study Type Mean Age Patient No. Definition of Morbidity AOR (%) AOE (No.) 95% CI (%) Mortality (%) 1 Charbel et al, 1991 (40) RS 43 22 Persistent deficits 18.2 4 11.4–22.7 0.0 2 Awad and Little, 1991 (41) RS 47 10 Requires occasional assistance 10.0 1 3.9–23.3 0.0 Median 3 Rabinowicz et al 1991 (42) RS Not reported 21 Permanent perioperative complications 19.1 4 12.0–28.9 0.0 4 Taylor et al, 1991 (43) RS Not reported 21 Moderate disability to vegetative state 0.0 0 0.0–4.5 0.0 5 Chehrazi, 1992 (13) RS 52 18 GOS moderate deficit to PVS/death 5.6 1 2.2–13.6 0.0 6 Symon, 1992 (12) RS Not reported 34 Author report 8.8 3 5.1–14.9 5.9 7 Inagawa et al, 1992 (18) RS Not reported 52 Author report 5.8 3 3.3–9.9 Not reported 8 Nakagawa and Hashi, 1994 (20) RS 55 20 Author report 5.0 1 1.9–12.3 0.0 9 Dickey et al, 1994 (44) RS 57 44 Author report 4.6 2 2.3–8.8 0.0 Median 10 Solomon et al, 1994 (21) RS Not reported 202 New neurologic deficits 12.4 25 10.3–14.9 6.9 11 Asari and Ohmoto, 1993 (45) RS Not reported 69 Worsened after surgery 7.3 5 4.7–11.0 0.0 12 Mizoi et al, 1995 (14) RS 57 90 Cannot perform normal activities 0.0 0 0.0–1.1 0.0 13 Dix et al, 1995 (46) RS Not reported 66 Cannot perform former activities 3.0 2 1.5–5.9 Not reported 14 Deruty et al, 1996 (25) RS Not reported 62 Author report 6.5 4 4.0–10.3 Not reported 15 Khanna et al, 1996 (47) RS Not reported 172 Inability to work, no self-care 9.9 17 7.8–12.4 Not reported 16 Leber et al, 1998 (35) RS Not reported 16 GOS ≤3 6.3 1 2.4–15.2 6.3 17 Lot et al, 1999 (37) RS Not reported 25 Moderate to severe deficit, death 4.8 3 6.9–20.0 0.0 18 Orz et al, 2000 (24) RM 62 310 Dependent life 5.8 18 4.6–7.3 0.3 19 Johnston et al, 2000 (22) RS 53 68 mRS change ≥2 25.0 17 20.2–30.6 1.5 20 Chyatte and Porterfield, 2001 (27) RS 55 366 mRS change ≥2 6.0 22 4.9–7.4 3.8 21 Kashiwagi et al, 2000 (23) RS 73 96 Dependent/dead 8.3 8 5.9–11.6 5.2 22 Raaymakers, 2000 (26) PM 44 18 mRS change of ≥2 22.2 4 14.1–33.3 0.0 23 Rinne et al, 1996 (48) CB 49 33 GOS moderate disability/death 12.1 4 7.6–18.9 0.0 24 Yamashita et al, 1997 (49) CB Not reported 349 GOS moderate disability/death 23.8 83 21.6–26.1 Not reported 25 Wiebers et al, 2003 (3) PM Not reported 995 mRS ≥3 15.2 151 14.1–16.4 1.8 26 Johnston et al, 1999 (36) RM 52 2358 D/C to nursing home/rehabilitation hospital 18.5 436 17.7–19.3 2.3 27 Johnston et al, 2001 (2) CB 54 1699 D/C to nursing home/rehabilitation hospital 25.1 426 24.0–26.1 3.5 28 Barker et al, 2003 (50) RC 64 3498 Death/discharge to other than home 20.4 714 19.7–21.1 2.1 29 Raftopoulos et al, 2003 (7) PS 49 33 mRS ≥3 3.0 1 1.2–7.6 0.0 30 Wiebers et al, 2003 (3) PM 52 1917 mRS 3–5 and/or impaired cognition 13.2 254 12.9–14.6 Not reported Note.—RS indicates retrospective single center; RM, retrospective multicenter; PM, prospective multicenter; CB, community-based; RC, retrospective cohort; AOR, adverse outcome rate; AOE, adverse outcome event; PVS, persistent vegetative state; GOS, Glasgow Outcome Scale; mRS, modified Rankin Scale.
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