Endovascular Coiling Compared With Surgical Clipping for Unruptured Intracranial Aneurysms in South Korean Study

June 13, 2018—An investigation of long-term outcomes of endovascular coiling versus surgical clipping for unruptured intracranial aneurysms in South Korea was published by Young Deok Kim, MD, et al online in Journal of NeuroInterventional Surgery (JNIS).

The investigators performed a nationwide retrospective cohort study using claims data from the Korean Health Insurance Review and Assessment Service on patients undergoing surgical clipping or endovascular coiling from 2008 to 2014. Inverse probability treatment weighting for average treatment effect on the treated and the multiple imputation method were used to balance covariates and handle missing values. The primary outcome was all-cause mortality at 7 years.

As summarized in JNIS, the investigators identified 26,411 patients, of whom 11,777 underwent surgical clipping and 14,634 underwent endovascular coiling.

The investigators found that after adjustment with the use of inverse probability treatment weighting for average treatment effect on the treated, all-cause mortality rates at 7 years were 3.8% in the endovascular coiling group and 3.6% in the surgical clipping group (hazard ratio [HR], 1.05; 95% confidence interval [CI], 0.86–1.28; P = .6, log-rank test). The adjusted probabilities of aneurysm rupture at 7 years were 0.9% after endovascular coiling and 0.7% after surgical clipping (HR 0.9; 95% CI, 0.61–1.34; P = .63, log-rank test). The probabilities of retreatment at 7 years after adjustment were 4.9% in the endovascular coiling group and 3.2% in the surgical clipping group (HR, 1.52; 95% CI, 1.28–1.81; P < .001, log-rank test).

All-cause mortality at 7 years was similar between the elective surgical clipping and endovascular coiling groups in patients with unruptured aneurysms who had no history of subarachnoid hemorrhage caused by aneurysm rupture, concluded the investigators in JNIS.