The patient characteristics are presented in Table 1.
The mean age of all patients was 53.17 years (range 21-73) and was similar in neurosurgical and radiological group (53.4 vs.
52.9; p=0.86). A sex distribution in the examined populations was comparable as well (p=0.51).
The majority of patients were women (77.9%).
The data concerning clinical condition of patients following subarachnoid hemorrhage is outlined in Table 2.
At the hospital admission the Hunt and Hess scale and Fisher scale grades were 1 or 2 in 61% and 33% of the cases respectively.
The aneurysm characteristics are reviewed in Table 3.
The MCAAs were more frequent on the right side when concerning total population (54.8%).
The most common location of the MCAAs was M2 - the MCA bifurcation area (91.8% of cases).
The average size of aneurysm was 6.93mm for coiling and 7.3mm for clipping,
the difference was not significant (p=0.73).
The mean dome-to-neck ratio was higher for the embolization than for neurosurgery (1.85 vs.
1.47),
the difference was statistically significant (p=0.02).
Thirty coiled (73.2%) and twenty seven clipped (84.4%) aneurysms were defined as complex (p=0.25).
Balloon or stent-assisted coil embolization was performed in seventeen MCAAs.
Table 4.
presents the clinical and radiological outcomes of the aneurysm treatment.
In the angiographic control of the procedure the complete or near-complete embolization was noticed in thirty three cases (94.3% of competed coilings).
In the intraoperative evaluation of clipping,
complete occlusion was affirmed in 100% of cases.
Average Glasgow Outcome Scale (GOS) score in the day of hospital discharge of the patient was 4.46 ± 1.05 in embolization group,
and 4.31 ± 1.00 in clipping group,
difference was not significant (p=0.38).
The average length of stay in the hospital was 8.7 ± 9.8 days for coiling and 13.44 ± 13.21 days for clipping (p=0.08),
however the Intensive Care Unit (ICU) stay was longer in the embolization group 2.23 vs.
0.88 days (the difference is not significant as well p=0.09).
One day stay on the ICU was mandatory for all patients who underwent endovascular embolization.
Early complications were observed in nine patients (28.1%) with clipping and in ten patients (24.4%) with coiling (p= 0.92),
however in additional four cases of intravascular embolization (9.76%) the procedure had to be stopped due to technical problems with catheterization of MCA or exacerbation of patient’s clinical condition (there were six procedure failures for coiling).
Table 5.
presents the clinical and radiological outcomes of the complex and non complex aneurysm treatment.
The complete or near-complete embolization was observed in twenty six cases (86.7%) in group of complex aneurysms and in seven (63.6%) of non complex aneurysms (p=0.23). Average GOS score was higher for coiled complex aneurysms: 4.50 ±1.14 vs.
4.36 ± 0.81 (p=0.028),
for clipping the difference was not significant: 4.44 ± 1.01 vs.
3.60 ± 0.55 (p=0.39).
The average length of stay in the hospital as well as on the ICU was higher for complex aneurysm in embolization group,
but shorter in surgical group (differences were not significant).
Early complications were more common for non complex aneurysms: 36.4% vs.
20.0% of embolizations (p= 0.25) and 60.0% vs.
22.2% of clipping (p= 0.12),
differences were not significant.
The embolization procedure failure rate was higher for the non complex aneurysms as well (27.3% vs.
10.0%; p= 0.18),
probably due to common use of balloon or stent assisted procedures for the complex aneurysms (53.3% vs.
9.1%; p= 0.018).
We have also analyzed if there was any differences between qualification and treatment effects of coiling and clipping of complex MCAAs (Fig. 4).
More detailed characteristics of all complications and procedure failures are presented in Table 6.