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Rebleeding Risk Low for Treated Intracranial Aneurysm

Five-year mortality rate lower in patients treated with coiling versus clipping

WEDNESDAY, April 1 (HealthDay News) -- Though the risk of recurrent bleeding in patients with a ruptured intracranial aneurysm is higher in those treated with endovascular coiling compared to surgical clipping, the risk of later death was lower in the coiled group, according to research published online March 28 in The Lancet Neurology.

Andrew J. Molyneux, M.D., of the John Radcliffe Hospital in Oxford, U.K., and colleagues analyzed data from 2,004 patients with ruptured intracranial aneurysms who were followed over the long term after their assignment to clipping or coiling.

After more than a year following treatment, rebleeds occurred in 24 patients, the investigators found. Thirteen of these occurred in the treated aneurysm: 10 in the coiling group and three in the clipping group. At five years, the risk of death was significantly lower in the coiling group (relative risk, 0.77), but the percentage of survivors at this point who were independent was virtually the same in both groups (82 percent for clipping and 83 percent for coiling), the researchers report.

"Coiling has benefits over surgery in those patients who are candidates for either treatment, but this difference decreases over time. The decision made for each patient must take into account many factors," writes the author of an accompanying editorial. "The initial decision with regard to coiling or clipping is only the first step in the management of patients who have an active cerebrovascular disease that might recur, and imaging of any persistant aneurysms and aggressive modification of risk factors are crucial for long-term management."

Several co-authors disclosed relationships with Micrus Endovascular and Boston Scientific.

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