Clipping vs Coiling

[Rifampicin]

The situation in neurosurgery is very similar to both CT and vascular. Catheter and wire skills have now become essentials if one is to practice vascular surgery, be it peripheral, cardio-, or cerebro- vascular. Thankfully neurosurgeons are very aggressive in learning interventional skills, so while there are also NIR and interventional neurologists who do cath, neurosurgeons will dominate the field in the long run given they're the only ones trained to perform both open microsurgical and interventional techniques.

So how is the volume for neurointerventional stuffs, specifically coiling vs surgical clipping for intracranial aneurysms in the US? Unlike CABG vs PCI debate, research seems to show decent 5-year outcomes for coiling. Are these things institution dependent? How's the future for aneurysm clipping?

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[mmmcdowe]

Aneurysm clipping is dwindling for better or worse.

 

[neusu]

As @mmmcdowe says, open vascular is diminishing. On the other hand, stroke intervention e.g. large vessel occlusion clot retrieval is about to explode.

 

[TUGM]

Neurointervention cases include the following: aneurysm coiling, AVF/AVM embolizations, tumor embolizations, intra-arterial chemotherapy (retinoblastoma), vasospasm, and stroke interventions; in some instances some minimally invasive spine therapy.

Aneurysm volumes have reached a plateau. Stroke intervention volumes will probably increase, though there won't be a "flood" given that most patients don't come within the proper time windows.

Intervention is done by mostly neurosurgeons and neurologists. Neurologists will have the ability to refer to themselves for stroke interventions, since they do medical stroke therapy, but neurosurgery has a good foothold in doing those procedures as well. Radiology numbers have probably gone down quite a bit.

But in response to your original question, as technology advances, most aneurysms will be treated endovascularly, though open cases will still be around for certain special situations, based on anatomy and accessibility.

 

[Rifampicin]

Interesting discussion, thanks for the answers everyone!