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Anterior Circulation Aneurysms: Clip or Coil?

Last Updated: September 28, 2018

PERSONAL PHILOSOPHY TO ANEURYSM CARE

Treatment of intracranial aneurysms has evolved over the past decade through the advent of innovative endovascular and refined microsurgical techniques. Most importantly, therapy should be individualized because each patient has a unique set of medical and pathoanatomic features that factor into the decision-making process for treatment. This phenomenon is especially true for aneurysm care.

Each aneurysm must be assessed for its size, shape, location, history of rupture, and presence of calcification or thrombus. The patient’s age, neurologic and clinical status, and family history are also important factors in estimating the natural history of each intracranial aneurysm. The optimal treatment strategy should provide benefit over the natural history of the aneurysm and aim for low rates of morbidity and high rates of aneurysm obliteration.

Outcome and complication rates of a treatment for a particular aneurysm are confounded by the surgeon’s training and recall biases. Existing clinical trials are not always conclusive because the success of treatment in the hands of a particular surgeon or interventionalist most likely reflects that surgeon’s or interventionalist’s experience and technical skill. There...

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