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2015 ; 94
(32
): e1313
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A Retrospective Study of Survivors of Endovascular Coiling for Posterior and
Anterior Aneurysms: Medical and Patient Perspectives
#MMPMID26266373
Wilson SJ
; Drackford R
; Holt M
Medicine (Baltimore)
2015[Aug]; 94
(32
): e1313
PMID26266373
show ga
This article documents the longer-term medical and psychosocial outcomes of
patients referred for endovascular coiling.There is limited research
investigating outcome following endovascular coiling for posterior compared to
anterior circulation aneurysms, and minimal understanding of how medical outcomes
relate to patient experiences of treatment and quality of life.We studied a
consecutive cohort of 80 patients referred Australia wide for endovascular
coiling between 1995 and 2003 (49% posterior; 76% ruptured; 69% women, mean age
51.5 years). We used a mixed methods approach, assessing medical outcome with the
Modified Rankin Scale (MRS) in 61 patients (76%), and health-related quality of
life and psychosocial functioning using the EuroQol questionnaire and a
qualitative semistructured interview in 49 patients (61%).Despite the high
proportion of posterior aneurysms, the majority of patients (80%) showed good
medical outcomes as indicated by regained independence of activities of daily
living (MRS score ?3). Patients with unruptured aneurysms were significantly more
likely to show good outcomes (P?0.04), whereas aneurysm location (posterior,
anterior, or mixed) showed no significant effect. In patients with good medical
outcomes, greater functional disability was associated with neurological
complications surrounding treatment (P?0.05). Good outcomes correlated with
higher EuroQol ratings (P?0.001) and the experience of less change after
treatment (P?0.001), although psychosocial adjustment issues were reported by
most of the patients, including those with no medical symptoms.These results
support the long-term efficacy of endovascular coiling, particularly for
posterior circulation aneurysms. They have implications for guiding clinicians
and patients in their choice of treatment, as well as the provision of
psychological counseling for patient adjustment issues posttreatment.