Treatment of Good-Grade Aneurysmal Subarachnoid Hemorrhage from a Ruptured Anterior Circulation Aneurysm Suitable for Either Coiling or Clipping

Clinical Scenario

This protocol applies to patients presenting with good-grade aneurysmal subarachnoid hemorrhage (aSAH) caused by rupture of an anterior circulation aneurysm that is anatomically and clinically suitable for both primary endovascular coiling and surgical clipping.

Approach

When both coiling and clipping are viable options, the preferred primary intervention is endovascular in nature. Surgical treatment remains a reasonable alternative when clinically indicated.

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References

DOI: 10.1161/str.0000000000000436

For patients with good-grade aSAH from ruptured aneurysms of the anterior circulation equally suitable for both primary coiling and clipping, primary coiling is recommended in preference to clipping to improve 1-year functional outcome.

For patients with good-grade aSAH from ruptured aneurysms of the anterior circulation equally suitable for both primary coiling and clipping, both treatment options are reasonable to achieve favorable long-term outcome.

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