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Clinical outcome and ischemic complication after treatment of anterior choroidal artery aneurysm: comparison between surgical clipping and endovascular coiling.

Authors
Kim, BM; Kim, DI; Shin, YS; Chung, EC; Kim, DJ; Suh, SH; Kim, SY; Park, SI; Choi, CS; Won, YS
Citation
AJNR. American journal of neuroradiology, 29(2):286-290, 2008
Journal Title
AJNR. American journal of neuroradiology
ISSN
0195-61081936-959X
Abstract
BACKGROUND AND PURPOSE: Although coiling has been favorably comparable with clipping for treatment of most intracranial aneurysms, there is a controversy on which modality is safer for anterior choroidal artery (AchoA) aneurysm. We retrospectively evaluated the clinical outcomes and treatment-related complications after surgical clipping and endovascular coiling of AchoA aneurysms. MATERIALS AND METHODS: Seventy-three AchoA aneurysms were recruited from 1895 intracranial aneurysms, which were treated either by surgical clipping or by endovascular coiling in 4 institutions between May 1999 and December 2006. The AchoA aneurysms were dichotomized according to the modality of treatment, the coil group (37 patients; 38 aneurysms) and the clip group (35 patients; 35 aneurysms). Clinical outcomes and incidence of treatment-related complications between 2 groups and the factors influencing the clinical outcomes were evaluated. RESULTS: There was no rebleeding in both groups during follow-up, for 4-72 months (mean, 27 months) in the coil group and for 3-84 months (mean, 34 months) in the clip group. In the coil group, 31 patients (83.8%) had favorable outcome (modified Rankin Scale score [mRS], 0-3). In the clip group, 31 patients (88.6%) had favorable outcome. The complication of coiling was transient contralateral hemiparesis in 2 patients, who recovered completely. The complications of clipping were permanent contralateral hemiparesis due to AchoA infarction in 4 patients and third-nerve palsy in 1 patient. Hunt and Hess grade 4 or 5 and AchoA infarction were significantly correlated with poor outcome (mRS, < or =4). Clipping had significantly higher incidence of AchoA infarction than coiling (P < .05). CONCLUSION: Coiling of AchoA aneurysms appears comparable with clipping in clinical outcome and prevention of rebleeding, with significantly lower incidence of AchoA infarction than clipping.
MeSH terms
AdultAgedBrain Ischemia/epidemiology*Choroid Plexus*ComorbidityFemaleHumansIncidenceIntracranial Aneurysm/epidemiology*Intracranial Aneurysm/therapy*MaleMiddle AgedNeurosurgical Procedures/statistics & numerical data*Risk Assessment/methods*Risk FactorsTreatment OutcomeVascular Surgical Procedures/statistics & numerical data*
DOI
10.3174/ajnr.A0806
PMID
18024579
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Neurosurgery
Journal Papers > School of Medicine / Graduate School of Medicine > Radiology
AJOU Authors
신용삼김선용
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