Search

Background: The dilemma concerning the appropriate treatment of the intracranial aneurysms (IAs) has not yet been resolved and still remains under fierce debate. This study refers to the recent trends in the use of and outcomes related to coiling compared with clipping for unruptured and ruptured IAs in Poland over a 4-year period., Methods: The analysis refers to treatment of IAs performed in Poland between 2009-2012. Patients' records were cross-matched by ICD-9 codes for ruptured SAH (430) or unruptured cerebral aneurysm (437.3) along with codes for clipping (39.51) and coiling (39.79, 39.72, or 39.52). Multivariable logistic regression was used to compare in-hospital deaths, hospital length of stay (LOS), therapy allocation and aneurysm locations in unruptured vs. ruptured and clipped vs. coiled groups. Differences in the number of procedures between 16 administrative regions were standardized per 100,000 people., Results: In 2009-2012, 11,051 procedures were identified, including 5,968 ruptured and 5,083 unruptured aneurysms. Overall increase was 2.3 % in clipping and 13.1 % in coiling; a significant trend was found in endovascular procedures (p = 0.044). Ruptured aneurysms were clipped more frequently (OR = 1.66;); in unruptured IAs, endovascular procedure was preferred 3.5 times more than clipping. The annual in-hospital mortality was 7.6 % in clipping and 6.7 % in endovascular treatment. LOS was two times longer after clipping in unruptured aneurysms (OR = 2.013). After the procedures were standardized per 100,000 people, the average for Poland was established as 9.09 in 2009, 10.86 in 2010, 10.55 in 2011, and 11.49 in 2012. This index had the highest values in Mazovia (12.9, 2009; 15.4, 2010; 17.4, 2011; 18.6, 2012., Conclusions: Data analysis revealed an increase in overall number of IAs treated in Poland between 2009-2012. A significant upward trend of endovascular procedures was found, whereas the number of clipped aneurysms remained relatively steady over the study period.

Aim: Complete aneurysm obliteration reduces the risk of rebleeding and is an important goal of the aneurysm treatment., Material and Methods: A retrospective analysis of 63 patients undergoing endovascular treatment of posterior circulation aneurysms. The occlusion rate was stratified to three groups: complete, incomplete and partial. In the analysis compared the influence of the selected characteristics: age, sex, WFNS grade, aneurysm location, size of the aneurysm dome and neck, neck to dome ratio, on the effectiveness of embolization in each group. A multi-factor analysis with probit model and linear regression was applied to assess the impact of all characteristics on the complete occlusion., Results: In the series of 63 single aneurysms, 51 were ruptured and 12 unruptured aneurysms. Complete occlusion was achieved in 36 (57.1%), incomplete in 15 (23.8%), partial in 12 (19%) patients. In patients with the neck size of 1-2 mm the complete occlusion was in 75% (24/32) incomplete in 12,5% (4/32), while when the neck size was 2-4 mm these rates were 38.7% (12/31) and 29% (9/31) respectively. The predictor of total occlusion in probit and linear regression model was only one independent variable, the narrow-neck size., Conclusion: Multi-factor analysis found that the strongest predictor of the complete occlusion is the aneurysm neck size.