[Coiling vs. clipping: hospital stay and procedure time in intracranial aneurysm treatment]. / Coil vs. Clip: Verweildauer und Behandlungszeit bei der Therapie intrakranieller Aneurysmen.

ABSTRACT

PURPOSE: Evaluation of hospital resource allocation in intracranial aneurysm treatment in a medium-volume neurovascular center. MATERIALS AND METHODS: Retrospective data analysis included 653 procedures performed on 598 patients with 667 aneurysms (A) from 1990 to 2004. 515 treatments were carried out in ruptured A (clip n = 370; coil n = 145) and 138 procedures in non-ruptured A (clip n = 51, coil n = 87). Patient management data included procedure time (min), length of stay in the intensive care unit (days), total length of hospital stay (days), and discharge to home ratio. RESULTS: Clinical admission grade (rupt. A Hunt and Hess grade 1 - 3 clip 73 % coil 72 %) and clinical outcome at discharge (good neurological outcome/mortality rate rupt. A clip 51.1/13.8 % coil 45.5 / 10.3 % non-rupt. A 88.2/0 % coil 88.5/1.3 %) were similar for both treatment modes. The coil procedure time was found to be significantly shorter (rupt. A coil 145 min; clip 203 min; p < 0.01; non-rupt. A coil 164 min, clip 200 min; p < 0.01). Coiling reduced the length of stay in the ICU (rupt. A coil 5.3 d; clip 6 d, p < 0.01; non-rupt. A coil 1.5 d; clip 2 d; p = 0.21) and coiling significantly reduced the length of hospital stay (rupt. A coil 21.4 d; clip 26.8 d, p < 0.01; non-rupt. A coil 9.2 d; clip 17.5 d; p = 0.01).The discharge to home ratio did not differ (rupt. A clip 31.6 % coil 29.7 % non-rupt. A clip 74.5 % coil 80.5 %). CONCLUSION: In a medium-volume neurovascular center, coiling significantly reduced the procedure time, the stay in the ICU, and the length of hospital stay suggesting favorable resource allocation in endovascular therapy.