Keywords:
CNS, Neuroradiology brain, Vascular, Catheter arteriography, CT-Angiography, Image manipulation / Reconstruction, Embolisation, Outcomes analysis, Diagnostic procedure, Aneurysms, Haemorrhage, Outcomes
Authors:
B. J. Kapustka1, K. J. Kubicki2, A. M. Matlak2, R. Sordyl2, S. Kwiek2, P. Bażowski2, D. T. Knap2, J. Baron2, J. Jaskólski3; 1Pawłowice/PL, 2Katowice/PL, 3Busko-Zdroj/PL
DOI:
10.1594/ecr2013/C-2116
Purpose
For last three decades the treatment of intracranial aneurysms has become as much radiological as neurosurgical problem.
However there is still no agreement which of these approaches is more beneficial for patients.
The initial (based on the one-year follow-up data) outcomes of the International Subarachnoid Aneurysm Trial (ISAT) published in 2002 [1] implied that endovascular coiling comparing to neurosurgical clipping seems to be a better therapeutic option for a ruptured intracranial aneurysms due to an absolute dependency or death risk reduction.
Findings of this study caused a rapid increase in number of intracranial aneurysms treated intravenously.
However recently published data concerning the long term observation of the ISAT group showed that coiling effects could be not as much favorable as they were reported earlier [2,3].
Moreover some authors suggest that ISAT conclusions are not entirely reliable for all intracranial aneurysms,
especially for those located in the Middle Cerebral Artery (MCA) [4].
Particularly the selection of the MCA aneurysms (MCAAs) treatment method is among the most controversial of all cerebral aneurysms.
Due to a specific local angioarchitecture of the MCA,
aneurysms located in that area are often challenging for an interventional radiologist,
but effects are considered to be similar to clipping [5] especially when using a Stent-Assisted Coiling [6].
On the other hand the MCAAs are relatively easily approachable for neurosurgical procedures and for that reason clipping is often a first line-treatment [4,7] .
Due to those facts the choice of the MCAAs treatment method should be very careful and based on aneurysm localization,
morphology and clinical features of the patient.
The objective of this exhibit is to assess and compare the early effects of endovascular and neurosurgical treatment of MCAAs in the Central Clinical Hospital of The Medical University of Silesia,
Katowice.
The secondary aim was to assess the indications and qualification conditions for the radiological and neurosurgical approach used in our Centre.