DiagnosticsNeurointerventionists Expand Research To Quality Of Life In Aneurysm Patients Following Minimally Invasive Coiling Treatment
Since the groundbreaking 2002 ISAT International Subarachnoid Aneurysm Trial (ISAT) which ultimately was halted due to overwhelming evidence that minimally invasive coiling (an endovascular therapy) was, on average, superior to traditional surgical clipping in the treatment of brain aneurysms many studies have continued to prove the short and long-term viability of this procedure. Further technical refinements for coiling are underway all over the world.
But while the efficacy of minimally invasive coiling has been proven many times over in the case of intracranial aneurysms (a bulge in the artery wall which can suddenly burst, leading to bleeding in the brain that may result in severe disability, or even death), less is known about the psychosocial functioning of these patients after undergoing the coiling treatment. In an abstract presented yesterday at the Society of NeuroInterventional Surgery (SNIS) 6th Annual Meeting in Boca Raton, FL, Antonio DeSimone, M.D., a neuroradiologist at the "San Giovanni Bosco" Hospital in Naples, Italy, shared data that indicates that while patients whose aneurysms were successfully treated with coiling may still need psychological support because of this life-changing event, this need is seen to a lesser degree than was previously reported after traditional surgical clipping. The study represents the largest case series to date addressing patient quality of life following coiling.
"Now that coiling has, in essence, reached early adulthood, and we are comfortable with the significant number of successfully treated patients," says DeSimone, "we are being called upon to now focus on subjects rather than simply the accumulation of cases. At present, the coiling technique is so advanced that research - that will help inform the areas of psychosocial functioning that could benefit from support is the next step we must take in our ongoing journey."
To evaluate quality of life in good-outcome patients undergoing maintenance follow-up angiography (a diagnostic test that infuses the blood vessels with dye in order to clearly visualize the vessel structures), study authors evaluated 30 subjects (including 12 males and 18 females ranging in age from 24 - 73 years of age) who were selected from their database of 248 coiled patients and who underwent the procedure in 2006 and 2007. Study subjects (the test group) were asked to complete the widely-used and validated Italian version of the "Medical Outcome Study 36-Item Short Form Questionnaire (SF-36)" that is utilized by psychologists to assess the quality of life of patients. The test allows for detailed analysis of eight different domains including: physical functioning, role limitations because of physical problems, bodily pain, general health, vitality, social functioning, role limitations because of emotional problems and mental health.
These scores were then compared to the scores of two other bodies of data, the first being data that was previously reported in medical literature for surgically clipped patients (at present, there is no opportunity to compare to patients who are surgically clipped as it is considered unethical to randomize patients to coiling versus clipping following sound evidence that demonstrates that if an aneurysm is suitable for either treatment, that coiling is associated with better results). An analysis of study results showed that with neurosurgical clipping (traditional surgery that requires opening the skull) for aneurysmal subarachnoid hemorrhage, a substantial proportion of subjects who demonstrate a sound recovery present with ongoing psychosocial disturbances. In contrast, the study shows that quality of life is affected to a lesser degree in good-outcome patients who underwent endovascular coiling.
In a second comparison, the test group scores were analyzed against a reference population consisting of fully healthy individuals. In this comparison, study results showed that overall scores between patients who had been successfully coiled and the reference population were not significantly different. However, further examination suggests that, on a scale of 0 to 100, the coiled population lost points in three specific areas related to mental well-being: 11 points in the area of social functioning; 17 points in the area of role limitations because of emotional problems; and 14 points in the category of mental health. These results indicate that some patients can be fragile, and thereby candidates for psychosocial support, even if initially rated as good-outcome subjects.
Coiling is performed by neurointerventional specialists with training and expertise in treating conditions in the brain through endovascular (or "through the blood vessel") means. The procedure is accomplished through a catheter or narrow tube that is inserted into the groin and threaded up through the arteries directly to the problem site in the brain. The coils, or mesh wires, are then inserted into the aneurysm in order to prevent the space from filling with blood and rupturing.
Approximately two million people in the United States have an unruptured aneurysm. It is estimated that approximately 30,000 Americans suffer from subarachnoid hemorrhage each year.
About SNIS
SNIS members are neurointerventional practitioners with backgrounds in neuroradiology, neurosurgery and neurology that come together in the shared discipline of neurointerventional surgery. Our practitioners specialize in minimally invasive and endovascular procedures to treat stroke, aneurysms, carotid stenosis and spine fractures. Over the past two decades, our physicians have made numerous contributions to the neurosciences including: advancing stroke treatment through catheter based therapy; innovating endovascular coiling for aneurysms; pioneering interventional procedures to treat fractures in the spine; and initiating the first-ever stroke registry to track procedural success in the treatment of acute stroke.
Society of NeuroInterventional Surgery