Allocation and cooperation of surgical and intravascular treatments for ruptured intracranial aneurysms: Current results with a "clipping- first" strategy

Following recent advances in intravascular surgery for aneurysms, it seems valuable to summarize the current status of intravascular and surgical treatments in patients with subarachnoid hemorrhage as well as cooperative strategies for both treatments. A total of 573 cases with subarachnoid hemorrhage in the past five years was retrospectively analyzed. Principle strategy during this period was to consider clipping first in the acute stage whenever possible, and coiling was considered first in cases with basilar tip and carotid cave aneurysms, vertebrobasilar dissections, higher patient age and poor general conditions. Independent daily activity with or without neurological deficits at discharge was achieved in 52.5% of all cases including non-surgical cases, and in 85.4% of clipped and 71.4% of coiled cases. Cooperative surgical and intravascular techniques were necessary and effective in preoperative test occlusion, intraoperative angiography, suction decompression, parent artery occlusion with bypass surgery, multiple aneurysms, and others. Since overall outcome of subarachnoid hemorrhage is not satisfactory, further advancement is desired in each of the surgical and intravascular techniques and their cooperative strategies.