Studies compare best ways to treat wide-neck aneurysms
Microsurgery with clips is weighed against coils, stents deployed via catheters

Date:
February 14, 2022
Source:
University of Texas Health Science Center at San Antonio
Summary:
Coils and stents less invasively repair brain aneurysms, but are
they superior to clips implanted during surgery? A study compares
the treatments.



FULL STORY ========================================================================== Aneurysms are weak, bulging portions of blood vessel walls. These
blood-filled sacs resemble balloons in structure and have necks like
balloons. Some aneurysms have larger necks and are called "wide-neck" aneurysms. These aneurysms, identified through imaging, can be
significantly more difficult to treat.


========================================================================== Justin Mascitelli, MD, FAANS, a neurosurgeon at The University of
Texas Health Science Center at San Antonio (UT Health San Antonio),
is a co-author on recently published multicenter studies that compared
a pair of treatments for wide-neck aneurysms: endovascular therapy and microsurgery. One study, published Nov. 5, 2021, evaluated the treatments
in ruptured wide-neck aneurysms (the EVERRUN Registry). The second study, published Dec. 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 off the aneurysm
by means of metal coils and/or mesh stents. The 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 aneurysm rupture (or rerupture) 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 on the aneurysm neck to seal off the blood
flow, again to prevent aneurysm rupture (or rerupture) in the future.

The EVERRUN Registry analysis published Nov. 5 reviewed one-year outcomes
of 87 ruptured aneurysms: 55 in patients treated with endovascular therapy
and 32 treated with microsurgery. The study demonstrated similar clinical outcomes in the two groups. Microsurgery was longer lasting, with 12.7
percent of patients in the endovascular therapy group needing retreatment versus no patients whose aneurysms were clipped during microsurgery.

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

"I was not surprised by the results in the ruptured aneurysm cohort of EVERRUN," Dr. Mascitelli, lead author of the publications, said. "The hypothesis was that microsurgical clipping would compare well to
advanced endovascular techniques for ruptured wide-neck aneurysms,
which is what we found. In the unruptured aneurysm cohort, however, the complication rate in the microsurgical arm was higher than expected. More investigations are warranted." Dr. Mascitelli will continue the studies through a $25,000 grant from the Joe Niekro Foundation. Mr. Niekro was
a major league baseball pitcher who died at age 61 in October 2006 after suffering a brain aneurysm. A knuckleballer, he won more than 140 games
with the Houston Astros.

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

special promotion Explore the latest scientific research on sleep and
dreams in this free online course from New Scientist -- Sign_up_now_>>> ========================================================================== Story Source: Materials provided by University_of_Texas_Health_Science_Center_at_San_Antonio.

Original written by Will Sansom. Note: Content may be edited for style
and length.


========================================================================== Journal Reference:
1. Justin R. Mascitelli, J Mocco, Trevor Hardigan, Benjamin
K. Hendricks,
James S. Yoon, Kurt A. Yaeger, Christopher P. Kellner, Reade A. De
Leacy, Johanna T. Fifi, Joshua B. Bederson, Felipe C. Albuquerque,
Andrew F.

Ducruet, Lee A. Birnbaum, Jean Louis R. Caron, Pavel Rodriguez,
Michael T. Lawton. Endovascular therapy versus microsurgical
clipping of unruptured wide-neck aneurysms: a prospective
multicenter study with propensity score analysis. Journal of
Neurosurgery, 2021; 1 DOI: 10.3171/ 2021.10.JNS211942 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/02/220214144020.htm

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