Clipping Versus Coiling for Ruptured MCA Aneurysms Associated with Intracerebral Hematoma Requiring Surgical Evacuation

Background Ruptured middle cerebral artery aneurysm (MCAa) can lead to intracerebral hematoma, and surgical evacuation can be performed in these cases. MCAa can be treated by clipping or before by endovascular therapy (EVT). Our objective was to compare the impact on the functional outcome of MCAa i...

Full description

Saved in:
Bibliographic Details
Published in:Neurocritical care 2023-08, Vol.39 (1), p.162-171
Main Authors: Metayer, Thomas, Dumot, Chloe, Bernard, Florian, Le Reste, Pierre-Jean, Bernat, Anne-Laure, Cebula, Helene, Mallereau, Charles-Henry, Peltier, Charles, le Guerinel, Caroline, Vivien, Denis, Piotin, Michel, Emery, Evelyne, Gillard, Vianney, Leclerc, Arthur, Magro, Elsa, Proust, Francois, Pelissou-Guyotat, Isabelle, Derrey, Stephane, Aldea, Sorin, Barbier, Charlotte, Borha, Alin, Nadin, Lawrence, Briant, Anais R., Gaberel, Thomas
Format: Article
Language:English
Subjects:
Aneurysms
Binomial distribution
Cohort analysis
Critical Care Medicine
Glasgow Coma Scale
Hematoma
Intensive
Intensive care
Internal Medicine
Life Sciences
Medical imaging
Medicine
Medicine & Public Health
Neurology
Neurosurgery
Original Work
Patients
Review boards
Stroke
Surgery
Tomography
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background Ruptured middle cerebral artery aneurysm (MCAa) can lead to intracerebral hematoma, and surgical evacuation can be performed in these cases. MCAa can be treated by clipping or before by endovascular therapy (EVT). Our objective was to compare the impact on the functional outcome of MCAa in patients with intracerebral hematoma requiring evacuation. Methods This is a multicenter, retrospective, cohort study with nine French neurosurgical units from January 1, 2013, to December 31, 2020. All participants were adult patients who required evacuation of an intracerebral hematoma. We looked for risk factors for poor outcomes by comparing the baseline characteristics and treatments performed by using the 6-month modified Rankin scale score. Poor outcomes were defined by an modified Rankin scale score of 3–6. Results A total of 162 patients were included. A total of 129 (79.6%) patients were treated by microsurgery, and 33 (20.4%) patients were treated by EVT. In multivariate analysis, factors associated with poor outcomes included hematoma volume, realization of a decompressive craniectomy, occurrence of procedure-related symptomatic cerebral ischemia, occurrence of delayed cerebral ischemia, and EVT. In the propensity score matching analysis ( n  = 33 per group), poor outcomes were observed in 30% of the patients in the clipping group versus 76% in the EVT group ( P  
ISSN:1541-6933
1556-0961
DOI:10.1007/s12028-023-01702-8