Abstract Details

Title Comparative Outcomes of Clipping versus Complex Endovascular Repair in Aneurysmal Subarachnoid Hemorrhage: A Two-center Study

Topic Neuro Trauma and Critical Care

Presentation(s) P9 - Poster Session 9 (5:00 PM-6:00 PM)

Poster/Presentation
Number 18-006

Objective To compare outcomes between complex endovascular aneurysm repair (C-EVAR) and surgical clipping in patients with ruptured cerebral aneurysms not amenable to conventional coiling.

Background Endovascular techniques for cerebral aneurysm repair continue to evolve. Current guidelines favor coiling for most cases of aneurysmal subarachnoid hemorrhage (aSAH). However, when aneurysms are not suitable for coiling, the optimal treatment approach remains uncertain. Options include surgical clipping or C-EVAR, such as flow diverters or stent-assisted coiling.

Design/Methods We conducted a retrospective review of consecutive aSAH patients treated at two academic centers (2016 to 2024 at one center, 2019 to 2024 at the other). Multivariable logistic and linear regression analyses were used to evaluate associations between treatment modality and outcomes. Outcomes included poor functional status at 3 months (defined as modified Rankin Scale [mRS] 3 to 6), discharge disposition, presence of cerebral infarction during hospitalization, and hospital length of stay.

Results Among 696 aSAH patients (mean age 57.8 years [SD 14.4], 65% female, 63% White), 123 (18%) underwent clipping and 169 (24%) received C-EVAR. Patients treated with clipping were younger (mean 52.8 vs. 57.9 years; p = 0.015) and less frequently White (54% vs. 67%; p = 0.016). Clipping was associated with higher odds of cerebral infarction (OR 1.8, 95% CI 1.12 to 2.85; p = 0.014), independent of age, Hunt and Hess grade, and modified Fisher score. There were no significant differences in poor functional outcome or discharge to long-term care between groups. Among survivors, hospital stay was longer for the clipping group (β = 3.2 days, 95% CI 0.4 to 6.0; p = 0.025).

Conclusions Although clipping was associated with higher rates of infarction and longer hospitalization, short-term functional outcomes were similar to those of patients treated with C-EVAR. Larger prospective studies are needed to assess long-term outcomes.

Authors/Disclosures
Yasaman Pirahanchi, MD (Brigham and Women's Hospital) PRESENTER	Dr. Pirahanchi has nothing to disclose.
Carlin Chuck	Mr. Chuck has received personal compensation for serving as an employee of Brown University. Mr. Chuck has received research support from NIH (Grant: T35-HL094308).
Jessica D. Azevedo, MD (UCSD Health)	Dr. Azevedo has nothing to disclose.
Christoph Stretz, MD, FAAN (Rhode Island Hospital, Department of Neurology)	The institution of Dr. Stretz has received research support from American Heart Association. The institution of Dr. Stretz has received research support from Duke University Medical Center/NIH. The institution of Dr. Stretz has received research support from University of Cincinnati/NINDS.
Radmehr Torabi (Rhode Island Hospital)	Radmehr Torabi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Silk Road Medical.
Reza Bavarsad Shahripour, MD (University of California, San Diego (UCSD))	Dr. Bavarsad Shahripour has nothing to disclose.
Jamie LaBuzetta, MD (UC San Diego Health)	Dr. LaBuzetta has nothing to disclose.
Navaz Karanjia, MD (University of California San Diego)	Dr. Karanjia has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Kenneth Sigelman, LLC. Dr. Karanjia has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Norris & Keplinger, LLC.
Matthew Steinberg	Mr. Steinberg has nothing to disclose.
Alexander A. Khalessi, MD, MS	Dr. Khalessi has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Medtronic. Dr. Khalessi has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Ospitek. Dr. Khalessi has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Proximie. Dr. Khalessi has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Synchron. Dr. Khalessi has received intellectual property interests from a discovery or technology relating to health care.
Karen L. Furie, MD (RIH/Alpert Medical School of Brown Univ)	The institution of Dr. Furie has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen/BMS. Dr. Furie has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for BMJ/JNNP. The institution of Dr. Furie has received research support from NINDS.
Ali Mahta, MD (Brown University)	Dr. Mahta has received research support from Brown University Health.

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