Treatment Pathways and Prognosis After Intra-Procedure Vascular Event: A Comparison of Invasive and Minimally Invasive Approaches

Abstract

This retrospective study aimed to assess and contrast the outcomes related to intraoperative rupture of aneurysms in patients with subarachnoid hemorrhage undergoing either surgical clipping or endovascular coiling. A total of 742 patients treated over a three-year span at the Clinical Department of Neurosurgery, Clinical Center of Serbia, were reviewed. Of these, 167 (31.15%) underwent surgical clipping and 33 (16.01%) underwent coiling within the early intervention window of 72 hours. Various pre-treatment variables and overall clinical outcomes were analyzed, with a specific focus on differences between those who experienced intraoperative rupture during the procedure.

Findings revealed that intraoperative aneurysmal rupture occurred more frequently in patients undergoing surgical intervention (14.7%) compared to those treated endovascularly (2.4%). The incidence was also higher in early interventions than delayed ones—27.5% and 9.7% in early microsurgery vs. 2.2% and 1.1% in delayed cases, respectively. Despite the higher rupture rate in open surgeries, mortality was significantly lower in the surgical group (11.4%) than in the endovascular group (60.0%). These results suggest that although intraoperative rupture is more common in surgical procedures, the overall patient outcome tends to be more favorable compared to endovascular approaches.