Coiling/clipping: The ideal treatment in Indian scenario

Introduction: Cerebral Aneurysm, aneurysmal sub arachnoid haemorrhage (SAH) has devastating consequences, and every patient should be treated and managed in emergency. The two different options available for the treatment are surgical clipping of the aneurysm or endovascular coiling. Also the post op management should be taken care for a better neurological outcome. Methods: It is a retrospective study from April 2009-Jan 2014 and prospective from Feb 2014-Jan 2015 of the patients who were symptomatic for aneurysmal SAH either ruptured/un-ruptured and underwent coiling or clipping for the aneurysm accordingly at KIMS hospital Secundrabad. A total of 244 patients over a period of 5 yrs where admitted for coiling or clipping who had either radiological or clinical evidence of aneurysm. Patient demography, Clinical grades, location of aneurysm, vasospasm and outcomes were analysed for both coiling and clipping. Results: A total of 191 patients underwent microsurgical clipping of which, 175 (92%) had anterior circulation aneurysm and 17 (18%) had posterior circulation aneurysm. Out of the operated 179 (94%) survived, and 12 (6%) expired. Similarly of the coiling patients 42 (70%) had anterior circulation aneurysm, and 18 (30%) had posterior circulation aneurysm. 1 patient in coiling had a rebleed, 4 of the patients from the coiling group eventually underwent clipping due to failed coiling. 56 (93%) survived and 4 (7%) died in coiling category. However the length of stay of the coiling patients was less i.e. 8 days when compared to clipping group where it was 13 days, but there was no significant outcome when compared to each other. Conclusions: In a developing country like India the cost of treatment of aneurysm and infrastructure required for endovascular coiling suite in most of the neuro center becomes a problem. In such a scenario our study supports that coiling and microsurgicalclipping have equal outcomes and patients should be offered both type of treatments.