Efficacy of Endovascular Treatment Versus Surgical Clipping for Rupture Intracranial Aneurysms
Keywords:
Ruptured intracranial aneurysm, endovascular treatment, surgical clipping, functional outcome, survival analysisAbstract
Background: Treatment options for intracranial aneurysms include surgical clipping and endovascular techniques such as coiling, stenting, and flow diversion. While clipping has been the traditional standard, it is associated with greater morbidity, whereas endovascular methods provide favorable perioperative outcomes but raise concerns regarding long-term durability. This study compares outcomes of these two modalities in ruptured intracranial aneurysms. Methods: A retrospective cohort study was conducted at Udonthani Hospital, Thailand, including 114 patients treated for ruptured intracranial aneurysms between 2022 and 2024. Patients were divided into surgical clipping (n=43) and endovascular treatment (n=71). Survival, perioperative factors, complications, and one-month functional outcomes were analyzed using Kaplan-Meier survival analysis and logistic regression. Results: Endovascular treatment showed superior one-month survival (91.55% vs. 58.14%, P<0.001) and better functional recovery (median mRS 1 [0–3] vs. 3 [1–4], P = 0.019). Clipping required longer operative time (170 ± 37.8 vs. 73.14 ± 30.77 minutes, P < 0.001) and higher blood loss (350 mL vs. 30 mL, P<0.001). Complication rates, including infarction, vasospasm, and hemorrhage, were comparable. Poorer outcomes correlated with higher Fisher grades, particularly grade 4. Logistic regression confirmed endovascular treatment as an independent predictor of favorable outcome (OR 1.38, P=0.019). Conclusions: Endovascular therapy provides better short-term survival and functional outcomes than surgical clipping for ruptured intracranial aneurysms, supporting its role as a preferred first-line approach in appropriate patients. Prospective studies are needed to evaluate long-term results and optimize treatment strategies.
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