Fate of clots in patients with subarachnoid hemorrhage after different surgical treatment modality: a comparison between surgical clipping and Guglielmi detachable coil embolization.

Abstract:

BACKGROUND:Subarachnoid clot is important in the development of delayed vasospasm after subarachnoid hemorrhage (SAH). OBJECTIVE:To compare the clearance of subarachnoid clot and the incidence of symptomatic vasospasm in surgical clipping and embolization with Guglielmi detachable coils for aneurysmal SAH. METHODS:The subjects were 115 patients with Fisher group 3 aneurysmal SAH on computed tomography scan at admission whose aneurysm was treated by surgical clipping (clip group; n = 86) or Guglielmi detachable coil embolization (coil group; n = 29) within 72 hours of ictus. Software-based volumetric quantification of the subarachnoid clot was performed, and the amount of hemoglobin in drained cerebrospinal fluid was measured. RESULTS:Clearance of the subarachnoid clot on the computed tomography scan was rapid in the clip group until the day after the operation but slow in the coil group (58.9% removed vs 27.8% removed; P = .008). However, postoperative clearance of the clot occurred more rapidly in the coil group. Reduction of the clot until days 3 through 5 did not differ significantly between the 2 groups (72.9% removed vs 75.2% removed). The amount of hemoglobin in the clip group was > 0.8 g/d until day 3 and then gradually decreased (n = 15), but hemoglobin in the coil group remained at > 0.8 g/d until day 5 (n = 17). The incidence of symptomatic vasospasm did not differ between the groups. CONCLUSION:Subarachnoid clot can be removed directly during surgical clipping, which is not possible with endovascular treatment. However, the percentage reduction of the clot on days 3 through 5 did not differ between the 2 groups.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Shirao S,Yoneda H,Ishihara H,Harada K,Ueda K,Sano Y,Kudomi S,Hayashi Y,Shigeeda T,Nakano K,Nomura S,Fujii M,Kato S,Suzuki M

doi

10.1227/NEU.0b013e318208f1ba

subject

Has Abstract

pub_date

2011-04-01 00:00:00

pages

966-73; discussion 973

issue

4

eissn

0148-396X

issn

1524-4040

journal_volume

68

pub_type

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