Fate of Clots in Patients With Subarachnoid Hemorrhage After Different Surgical Treatment Modality: A Comparison Between Surgical Clipping and Guglielmi Detachable Coil Embolization

Neurosurgery 68:966–973, 2011 DOI: 10.1227/NEU.0b013e318208f1ba 

Subarachnoid clot is important in the development of delayed vasospasm after subarachnoid hemorrhage (SAH).

OBJECTIVE: To compare the clearance of subarachnoid clot and the incidence of symptomatic vasospasm in surgical clipping and embolization with Guglielmi detachable coils for aneurysmal SAH.

METHODS: The subjects were 115 patients with Fisher group 3 aneurysmal SAH on computed tomography scan at admission whose aneurysm was treated by surgical clipping (clip group; n = 86) or Guglielmi detachable coil embolization (coil group; n = 29) within 72 hours of ictus. Software-based volumetric quantification of the subarachnoid clot was performed, and the amount of hemoglobin in drained cerebrospinal fluid was measured.

RESULTS: Clearance of the subarachnoid clot on the computed tomography scan was rapid in the clip group until the day after the operation but slow in the coil group (58.9% removed vs 27.8% removed; P = .008). However, postoperative clearance of the clot occurred more rapidly in the coil group. Reduction of the clot until days 3 through 5 did not differ significantly between the 2 groups (72.9% removed vs 75.2% removed). The amount of hemoglobin in the clip group was . 0.8 g/d until day 3 and then gradually decreased (n = 15), but hemoglobin in the coil group remained at . 0.8 g/d until day 5 (n = 17). The incidence of symptomatic vasospasm did not differ between the groups.

CONCLUSION: Subarachnoid clot can be removed directly during surgical clipping, which is not possible with endovascular treatment. However, the percentage reduction of the clot on days 3 through 5 did not differ between the 2 groups.