Endovascular Coiling versus Surgical Clipping for Poor-Grade Ruptured Intracranial Aneurysms: Postoperative Complications and Clinical Outcome in a Multicenter Poor-Grade Aneurysm Study

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Fig 1.
Study flow diagram. The asterisk indicates that 1 center was excluded because enrollment was not consecutive and 8 patients were lost to follow-up.
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Fig 2.
Outcome at 12 months in all patients. A, Outcome according to WFNS grade. B, Outcome by type of treatment in all patients.

Table 1:

Baseline characteristics

Variables	Coiling (n = 133)	Clipping (n = 129)	P Value
Age (yr)	54.5 (11.8)	54.4 (10.9)	.960
Women	62 (46.6%)	69 (53.5%)	.266
Hypertension	50 (37.6%)	63 (48.8%)	.066
Current smoking	49 (36.8%)	32 (24.8%)	.035
Diabetes mellitus	10 (7.5%)	4 (3.1%)	.168
Previous ischemic stroke	3 (2.3%)	4 (3.1%)	.719
Previous SAH	4 (3.0%)	9 (7.0%)	.163
GCS score	7.5 (2.6)	6.4 (2.4)	<.001
WFNS grade			.002
Grade IV	82 (61.7%)	55 (42.6%)
Grade V	51 (38.3%)	74 (57.4%)
Fisher grade	3.1 (0.9)	3.6 (0.7)	<.001
Modified Fisher grade	2.5 (1.1)	2.9 (0.9)	.001
Intraventricular hemorrhage	52 (39.1%)	51 (38.8%)	.955
Brain herniation	17 (12.8%)	51 (39.5%)	<.001
Multiple aneurysms	22 (16.5%)	24 (18.6%)	.661
Aneurysm size (mm)	5.7 (2.9)	6.0 (3.9)	.536
Ruptured aneurysm location			<.001
Anterior circulation	107 (80.5%)	128 (99.2%)
Posterior circulation	26 (19.5%)	1 (0.8%)
Preoperative EVD	10 (7.5%)	11 (8.5%)	.778
Postoperative EVD	37 (27.8%)	8 (6.2%)	<.001
Time to treatment			.544
0–72 hr	101 (75.9%)	102 (79.1%)
73 hr to 21 days	32 (24.1%)	27 (21.1%)
Hospital stay (days)	24.3 (20.7)	23.3 (21.4)	.721

Table 2:

Major complications associated with coiling compared with clipping

Complications	Coiling	Clipping	Crude Analysis		Adjusted Analysis
Complications	Coiling	Clipping	OR (95% CI)	P Value	OR (95% CI)	P Value
Aneurysm rebleeding	6 (4.5%)	2 (1.6%)	3.00 (0.59–15.15)	.180	3.41 (0.55–21.27)	.189
Cerebral infarction	15 (11.3%)	23 (17.8%)	0.59 (0.29–1.18)	.140	0.62 (0.26–1.49)	.283
Symptomatic vasospasm	14 (10.5%)	13 (10.1%)	1.05 (0.47–2.33)	.910	0.53 (0.18–1.59)	.259
Radiologic hydrocephalus	19 (14.3%)	7 (5.4%)	2.91 (1.18–7.17)	.020	3.36 (1.13–10.01)	.030
Clinical hydrocephalus	14 (10.5%)	2 (1.6%)	7.47 (1.66–33.57)	.009	5.15 (0.95–27.89)	.057
Seizure	5 (3.8%)	6 (4.7%)	0.80 (0.24–2.69)	.720	0.72 (0.18–2.85)	.641
Pneumonia	31 (23.3%)	39 (30.2%)	0.70 (0.41–1.22)	.210	0.61 (0.30–1.24)	.173
Renal failure	2 (1.5%)	5 (3.9%)	0.38 (0.07–1.99)	.250	0.24 (0.02–2.45)	.230

Table 3:

Multivariate analysis of predictors of hydrocephalus

Table 4:

Clinical outcomes associated with coiling compared with clipping

Outcomes	Coiling	Clipping	Crude Analysis		Adjusted Analysis
Outcomes	Coiling	Clipping	OR (95% CI)	P Value	OR (95% CI)	P Value
At discharge
mRS (0–1)	30 (22.6%)	22 (17.1%)	1.42 (0.77–2.62)	.266	0.62 (0.28–1.38)	.241
mRS (0–2)	48 (36.1%)	30 (23.3%)	1.86 (1.09–3.20)	.024	0.74 (0.35–1.60)	.448
mRS (0–3)	51 (38.3%)	34 (26.4%)	1.74 (1.03–2.94)	.039	0.66 (0.31–1.39)	.273
Death	27 (20.3%)	24 (18.6%)	1.11 (0.60–2.06)	.729	1.88 (0.84–4.25)	.127
At 6 Mo
mRS (0–1)	51 (38.3%)	29 (22.5%)	2.15 (1.25–3.69)	.006	1.34 (0.69–2.62)	.394
mRS (0–2)	61 (45.9%)	42 (32.6%)	1.76 (1.06–2.90)	.028	0.92 (0.48–1.79)	.808
mRS (0–3)	66 (49.6%)	54 (41.9%)	1.37 (0.84–2.23)	.208	0.64 (0.33–1.26)	.195
Death	47 (35.3%)	52 (40.3%)	0.81 (0.49–1.33)	.407	1.80 (0.91–3.54)	.091
At 12 Mo
mRS (0–1)	58 (43.6%)	37 (28.7%)	1.92 (1.15–3.21)	.012	0.98 (0.51–1.91)	.961
mRS (0–2)	68 (51.1%)	47 (36.4%)	1.83 (1.11–2.99)	.017	0.75 (0.38–1.49)	.410
mRS (0–3)	71 (53.4%)	55 (42.6%)	1.54 (0.95–2.51)	.082	0.61 (0.31–1.22)	.162
Death	48 (36.1%)	55 (42.6%)	0.76 (0.46–1.25)	.279	1.70 (0.86–3.33)	.125