Endovascular coiling versus neurosurgical clipping in patients with a ruptured basilar tip aneurysm.

OBJECTIVES To compare endovascular coiling with neurosurgical clipping of ruptured basilar bifurcation aneurysms. METHODS Patient and aneurysm characteristics, procedural complications, and clinical and anatomical results were compared retrospectively in 44 coiled patients and 44 patients treated by clipping. The odds ratios for poor outcome (Glasgow outcome scale 1, 2, 3) adjusted for age, clinical condition, and aneurysm size were assessed by logistic regression analysis. RESULTS In the endovascular group, five patients (11%) had a poor outcome v 13 (30%) in the surgical group; the adjusted odds ratio for poor outcome after coiling v clipping was 0.28 (95% confidence interval, 0.08 to 0.99). Procedural complications were more common in the surgical group. Optimal or suboptimal occlusion of the aneurysm immediately after coiling was achieved in 41 patients (93%). Clipping was successful in 40 patients (91%). CONCLUSIONS The results suggest that embolisation with coils is the preferred treatment for patients with ruptured basilar bifurcation aneurysms.