To clip or coil? Proposal of individual decision making

摘要

BackgroundOnce the decision is made to treat the intracranial aneurysm, we should consider between two competing treatment options; open surgery or endovascular therapy. The rationale underlying the choice of treatment modality is usually unclear, as there is little good quality evidence available.MethodsWe discuss here the patient, risk factors and the aneurysm related factors for decision making in management of intracranial aneurysm between endovascular and microsurgical modalities of management.ResultsThe relevance of age of patient, modifiable and nonmodifiable risk actors, family history, rupture status of aneurysm, aneurysm related factors like morphology of aneurysm and multiplicity are discussed here. Perceived differences in efficacy and safety of the two different treatment approaches are commonly used in an attempt to justify treatment choices. Difficulties with treatment selection and case to case management plan should be considered.ConclusionProperly designed and randomized controlled trials need to be done to address these issues for choosing best management to the patient and definitive guidelines must be made to solve this confusion.