How is it decided whether an aneurysm should be managed by coiling or clipping?

  • Should be an MDT decision made by experienced surgeons and radiologists
  • Decision based on:
    • Characteristics of the patient:
      • Surgical approach favoured in younger age and in presence of space occupying ICH
      • Radiological approach favoured in older age, poor grade SAH and in presence of significant co-morbidities
    • Characteristics of the aneurysm:
      • Surgical approach favoured with:
        • Middle cerebral artery aneurysm
        • Wide aneurysm neck
        • Arterial branches exiting directly out of the aneurysmal sac
      • Radiological approach favoured with:
        • Posterior location
        • Small aneurysm neck
      • Technical skills and availability
  • Coiling is the preferred treatment where it is judged that the aneurysm is amenable to either coiling or clipping
ESO Guidelines

G

AHA Guidelines

G