Rate of postoperative cerebral ischemia is reduced with Endovascular coiling than with surgical clipping

A recent study found that there was a higher incidence of postoperative cerebral ischemia after posterior communicating artery (PCoA) aneurysm clipping than after endovascular coiling. The study results were published in the journal BMC Neurology. 

Posterior communicating artery (PCoA) aneurysms are very common and nearly half of all internal carotid artery aneurysms are PCoA. They are generally managed by surgical clipping and endovascular coiling. But PCoA aneurysms are associated with a higher incidence of postoperative cerebral ischemia. Though literature in the past mentions about their incidence, researchers conducted a study to compare the cerebral ischemia in patients who underwent clipping or coiling of PCoA aneurysms and perform a detailed analysis of the same. 

A retrospective review of the patients who underwent surgical clipping or endovascular coiling was done from January 2017 to December 2019. Clinical and imaging data of patients with at least one PCoA aneurysm were analyzed. Cerebral ischemia was clinically assessed before treatment and at discharge using the National Institutes of Health Stroke Scale (NIHSS). Modified Rankin Scale (mRS) score was determined at discharge and six months after discharge.

Results

• Three hundred sixty-three aneurysms in 353 patients were included for analysis, 257 in the clipping group, and 106 in the coiling group.
• There was no difference between groups in terms of baseline characteristics. 
• The clipping group showed a higher incidence of postoperative cerebral ischemia (23.35% vs. 11.32%, p = 0.029).
• At discharge clipping group showed a significantly higher proportion of patients with a modified Rankin Scale score ≥ 2 (35.80% vs. 15.09%; p < 0.05) but not six months after discharge (15.56% vs. 8.49%; p > 0.05).
• In the clipping group, the mean age was significantly higher in patients who developed cerebral ischemia than in those who did not.
• In the coiling group, modified Fisher grade and incidence of fetal PCoA were significantly higher in patients who developed ischemia.  

This study was the first study to perform a detailed analysis of cerebral ischemia in PCoA aneurysm patients. As the causes and characteristics of postoperative cerebral ischemia after PCoA clipping and coiling are different management should be planned accordingly. 

Cai, Y., Zhang, T., Zhao, J. et al. Cerebral ischemia after treatment of posterior communicating artery aneurysms: clipping versus coiling. BMC Neurol 22, 436 (2022). https://doi.org/10.1186/s12883-022-02962-1