Authors' objectives:

The purpose of this literature review was to assess the effectiveness and cost-effectiveness of coil embolization, compared with open surgical clipping, to treat intracranial aneurysms.

Authors' recommendations: Level 1 evidence showed that at one year following the procedure, coil embolization is safe and yields better functional outcomes for patients who experienced subarachnoid hemorrhages from acute ruptured aneurysms that were equally suitable for treatment by either endovascular or surgical therapy. Level 4 evidence suggests that coil embolization of unruptured aneurysms may be associated with comparable or lower rates of mortality and morbidity, shorter hospital stays, and less need for discharge to short-term rehabilitation facilities. The greatest benefit was observed in people over 65 years of age. At present, surgical clipping appears to be the gold standard for treating intracranial aneurysms in eligible patients because of its established long-term effectiveness. The decision to choose surgical clipping or coil embolization needs to be made jointly by the neurosurgeon and neurointervention specialist, based on assessing the risk of rupture against the risk of the procedure, as well as the morphology of the aneurysm. Coil embolization offers a means of aneurysm treatment for people for whom treatment is necessary but surgical clipping is too risky or not feasible. It should be considered under the following circumstances : - Patients in poor/unstable clinical or neurological state - Patients at high risk for surgical repair (e.g., people aged 65 years or older or with comorbid conditions) - Aneurysms with poor accessibility or visibility for surgical treatment due to their location (e.g., ophthalmic or basilar tip aneurysms) Coil embolization may also be used in place of surgical clipping for other intracranial aneurysms predicated on the morphology of the aneurysm, and at the discretion of the neurosurgeon and the neurointervention specialist. The extent of aneurysm obliteration after coil embolization remains lower than that achieved with surgical clipping. Aneurysm recurrences after successful coiling may require repeat treatment with endovascular or surgical procedures. It is cautioned that the long-term outcomes of coil embolization are unknown at this time. Long-term follow-up after coil embolization is important. Endovascular coil embolization should take place in centres with expertise in neurosurgery and endovascular neurointerventions that have adequate treatment volumes to maintain good outcomes. Distribution of the technology should also take into account that patients with subarachnoid hemorrhage should be treated as soon as possible with minimal disruption if possible.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.health.gov.on.ca/english/providers/program/mas/tech/techlist_ mn.html

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Medical Advisory Secretariat

Contact Address: Medical Advisory Secretariat, 20 Dundas Street West, 10th Floor, Toronto, ON M5G 2N6 CANADA. Tel: 416-314-1092l; Fax: 416-325-2364;

Contact Name: MASinfo.moh@ontario.ca

Contact Email: MASinfo.moh@ontario.ca

Copyright: Medical Advisory Secretariat, Ontario Ministry of Health and Long-Term Care