Coiling or clipping? Treatment of intracranial aneurysms

Until recently the preferred treatment option for patients with intracranial aneurysms was a surgical repair intervention, during which the skull was opened and a clip was placed on the bulge in the threatened artery. This so called ‘clipping operation’ has been shown effective in preventing (recurrent) life threatening ruptures and subarachnoid hemorrhage. However, in the mean time a new treatment modality has been introduced, the so called ‘coiling procedure’, in which a catheter is inserted via an incision in the groin and pushed up into the aneurysm, where a platinum coil is placed in position. A big advantage of this endovascular approach is the avoidance of open surgery of the cranium. However, not yet every type of aneurysm can be effectively treated in this way.
The introduction and application of coiling has had important consequences for the care of patients with intracranial aneurysms. In this report the treatment outcomes of both clipping and coiling procedures, in terms of safety and efficacy in the short as well as the long run, are analyzed and compared. This shows that coiling of intracranial aneurysms is sufficiently safe and associated with important advantages over a clipping operation. In particular patients with subarachnoid hemorrhage from a ruptured aneurysm, show better functional rehabilitation after endovascular coiling, when compared to clipping. Also recurrent bleeding is more effectively prevented. Patients with an unruptured aneurysm also show better outcomes with coiling, as compared to clipping, especially patients at an advanced age and with a poor clinical status.