Microsurgery with clips is compared to coils, stents deployed via catheters – ScienceDaily

Aneurysms are weak, bulging parts of the walls of blood vessels. These blood-filled sacs resemble balloons in structure and have balloon-like necks. Some aneurysms have wider necks and are called wide neck aneurysms. These aneurysms, identified by imaging, can be much more difficult to treat.

Justin Mascitelli, MD, FAANS, a neurosurgeon at the University of Texas Health Sciences Center at San Antonio (UT Health San Antonio), is a co-author of recently published multicenter studies that compared a pair of treatments for wide neck aneurysms: endovascular therapy and microsurgery. A study, published November 5, 2021, evaluated treatments for ruptured wide neck aneurysms (EVERRUN registry). The second study, published on December 24, 2021, made the comparison in unruptured wide neck aneurysms. The studies are published in the Journal of Neurosurgery and were supported by a 2017 grant from The Bee Foundation.

Endovascular therapy is a minimally invasive way to seal the aneurysm using metal coils and/or mesh stents. Coils or stents are delivered to the aneurysm or blood vessel, respectively, through a catheter. These devices promote thrombosis of the aneurysm and prevention of rupture (or rerupture) of the aneurysm in the future.

During microsurgery, meanwhile, surgeons approach the aneurysm through the skull using a microscope to surgically dissect the small blood vessels. A small metal clip is placed over the neck of the aneurysm to seal off blood flow, again to prevent the aneurysm from rupturing (or re-rupturing) in the future.

The EVERRUN Registry analysis published Nov. 5 looked at the one-year outcomes of 87 ruptured aneurysms: 55 in patients treated with endovascular therapy and 32 treated with microsurgery. The study demonstrated similar clinical results in both groups. Microsurgery lasted longer, with 12.7% of patients in the endovascular treatment group requiring retreatment versus no patients whose aneurysms were clipped during microsurgery.

The analysis of unruptured aneurysms published Dec. 24 reviewed the one-year outcomes of 224 unruptured wide-neck aneurysms: 140 in the endovascular treatment group and 84 in the microsurgery group. Better clinical results and fewer complications were observed in the endovascular treatment group, but better results on aneurysm angiograms were observed in the microsurgery group.

“I was not surprised by the results of the EVERRUN ruptured aneurysm cohort,” said Dr. Mascitelli, lead author of the publications. “The hypothesis was that microsurgical clipping would compare well to advanced endovascular techniques for ruptured wide neck aneurysms, which we found. In the unruptured aneurysm cohort, however, the complication rate in the microsurgical arm was higher than expected. guaranteed.”

Dr. Mascitelli will continue his studies with a $25,000 grant from the Joe Niekro Foundation. Mr Niekro was a Major League Baseball pitcher who died aged 61 in October 2006 after suffering a brain aneurysm. Knuckleballer, he won more than 140 games with the Houston Astros.

The co-authors of the Journal of Neurosurgery articles are from UT Health San Antonio; the Barrow Neurological Institute in Phoenix, Arizona; the Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Health System, New York; and Yale Medical School.

Source of the story:

Material provided by University of Texas Health Sciences Center at San Antonio. Original written by Will Sansom. Note: Content may be edited for style and length.

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