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Vol. 29. Issue 6.
Pages 267-274 (November - December 2018)
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Vol. 29. Issue 6.
Pages 267-274 (November - December 2018)
Clinical Research
DOI: 10.1016/j.neucie.2018.09.002
Clinical results and costs of endovascular treatment in comparison with surgery in non ruptured aneurysms
Resultados clínicos y de costes del tratamiento endovascular frente al quirúrgico en aneurismas incidentales
Angel Horcajadas
Corresponding author

Corresponding author.
, Isabel Ortiz, Ana M. Jorques, Majed J. Katati
Neurocirugía, Hospital Virgen de las Nieves, Granada, Spain
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Figures (2)
Tables (6)
Table 1. Cost guide.
Table 2. Clinical and angiographic characteristics of the series.
Table 3. Location of the aneurysms.
Table 4. Mean stay, clinical and angiographic outcomes.
Table 5. Morbidity and mortality of incidental aneurysm treatment.
Table 6. Summary of the studies published on the costs of incidental aneurysm treatment.
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To evaluate the results and costs of surgical treatment against endovascular in non-ruptured aneurysms.

Material and methods

Retrospective study of consecutive series non-ruptured aneurysms from a single-centre treated endovascularly (EV) and surgically (SC). A descriptive study of demographic (age, sex), characteristics of the patients and the radiological aspects of the aneurysms have been carried out. Clinical results (GOS at 6 months), angiographic data (occlusion classification) and economic costs have been evaluated in both globally, and in each of the groups.


89 patients treated between 2010 and 2015 were reviewed. Most of them were treated endovascularly (74%). There were no statistically significant differences between EV and SC groups. 89% of the patients presented favourable GOS (4–5) at six months, being this percentage similar in both groups. Complete occlusion was much higher in SC group (96%) than in EV (55%). Retreatment rate was 24% in EV group and 0% in SC group. The retreatments were more frequent in anterior circulation aneurysms and bigger aneurysms (>10mm). The expenses in the SC group come mainly from hospital stay, meanwhile in the EV group is due to embolisation materials. The average length of stay (ALOS) is higher in SC group but costs of first admission are higher in EV group (14% more). When the costs of retreatments and follow up are included the costs of endovascular treatment is much higher than the surgical (61% more expensive).


results of both types of treatment are comparable. The grade of aneurysmal occlusion of the SC group was higher than the EV, as well as the stability of the treatment, requiring fewer retreatments. Although the ALOS in SC group were longer, the costs of the EV group were significantly higher than the SC group due to the costs of embolisation materials, follow up that they need and the rate of retreatment. Adequate selection of candidates for endovascular coiling could improve angiographic outcomes, reduce retraction rates, and save costs.

Subarachnoid hemorrhage
Cost effectiveness
Brain aneurysm

Evaluar los resultados clínicos y angiográficos, así como los costes del tratamiento quirúrgico frente al endovascular, en el tratamiento de los aneurismas incidentales.

Material y métodos

Estudio retrospectivo de una serie consecutiva de 89 pacientes de un solo centro tratados endovascularmente (EV) y quirúrgicamente (SC). Se realiza estudio descriptivo de aspectos demográficos (edad, sexo) y de las características de los aneurismas así como se evalúan resultados clínicos (GOS a 6 meses), angiográficos (grado de oclusión) y de costes económicos tanto globalmente como de cada uno de los grupos.


Ochenta y nueve pacientes tratados entre 2010 y 2015. Un 74% de los pacientes recibieron tratamiento endovascular y un 26% quirúrgico. No hubo diferencias significativas en cuanto a edad o sexo entre los grupos EV y SC. Un 89% de los pacientes presentaron GOS a los 6 meses favorable (4-5), sin diferencias entre ambos grupos. La oclusión completa del aneurisma fue mayor en el grupo SC (96% versus 55%), así como la estabilidad del tratamiento (24% de retratamientos en el grupo EV versus 0% en el grupo SC). Los retratamientos son más frecuentes en aneurismas de circulación anterior (27%) y de mayor tamaño (un 38,5% de los mayores de 10 mm). El gasto en el grupo SC viene derivado fundamentalmente de la estancia hospitalaria en tanto que en grupo EV tiene más importancia el coste de los materiales de embolización. Las estancias medias son notablemente superiores en el grupo SC pero el coste medio del primer ingreso es un 14% superior en el grupo EV debido al precio de los materiales de embolización. El gasto total es notablemente superior en el grupo EV (un 61%) debido a los gastos derivados del seguimiento y de los retratamientos.


Los resultados clínicos de ambos tipo de tratamiento son comparables. El grado de oclusión aneurismática del grupo SC es superior al del EV, así como la estabilidad del tratamiento, precisando menos retratamientos. A pesar de que el tratamiento quirúrgico genera estancias más largas, los costes del grupo EV son notablemente superiores a los del grupo SC debido al precio de los materiales de embolización, el seguimiento que precisan y la tasa de retratamientos. Una adecuada selección de los casos candidatos a coiling o pinzamiento podría mejorar los resultados angiográficos, reducir la tasa de retratamientos y ahorrar costes.

Palabras clave:
Hemorragia subaracnoidea
Aneurisma cerebral


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