gms | German Medical Science

Objective: Microsurgical clipping and endovascular coiling are safe and efficient treatment options for both ruptured and unruptured intracranial aneurysms. We hypothesized that complication and morbidity rates would be increased in patients with a previous subarachnoid haemorrhage (SAH) that were treated for a recurrent or an additional, initially unruptured aneurysm on an elective basis.

Methods: This is a retrospective, single-center analysis of consecutive patients that underwent elective treatment for intracranial aneurysms by microsurgical clipping or endovascular therapy between 2010 and 2018. We analysed complications rates and functional outcome (modified Rankin scale, mRS) in patients with a previous SAH and compared the results to patients without history of SAH.

Results: A total of 301 patients were enrolled, 236 in the non-SAH group and 65 in the SAH group. Patients in the SAH group were younger (54.2 ± 12.0 vs. 50.8 ± 12.2 years, p = 0.04) and had a worse pre-procedural mRS score (mRS≤1: 79% vs. 93%, p=0.01) than patients in the non-SAH group. Procedure-related complications occurred in 15.4% among patients with previous SAH and in 12.7% among patients without SAH, which was not statistically significant (p=0.6). At the 6-month follow up, neurological worsening (defined as any increase on the mRS scale) was comparable between the SAH group (7.7%) and the non-SAH group (6.8%, p=0.8). A similar portion of patients achieved favourable outcome (mRS score > 2) in the SAH group (95.4%) and in the non-SAH group (98.3%, p=0.17). Moreover, among patients with a previous SAH, the choice of microsurgical clipping or endovascular treatment did not have a significant impact on clinical outcome at the 6-month follow-up.

Conclusion: Both surgical and endovascular treatment of recurrent or additional aneurysms in patients with a previous SAH is reasonably safe with similar complication rates and morbidity, when compared to patients without history of SAH.