How Many Coils Do Patients With Aneurysmal Subarachnoid Hemorrhage Need?

Pedro Schestatsky and

Paulo Dornelles Picon

Originally published29 Oct 2009https://doi.org/10.1161/STROKEAHA.109.552356Stroke. 2009;40:e718

To the Editor:

Congratulations for the very relevant work from Bederson et al1 addressing the evidence-based management of aneurysmal subarachnoid hemorrhage. However, the authors did not provide data on the average number of needed coils for each procedure. This issue is extremely important for many public health systems around the world that guarantee free distribution of high-cost treatments for their population. Therefore, we believe that such information, which is unavailable in many important trials analyzing coil embolization for aneurysmal subarachnoid hemorrhage,2–4 should be taken into account in future neurosurgical guidelines.

Response:

The letter by Drs Schestatsky and Picon brings to light the economics of medical care that are difficult to generalize within a particular nation and impossible globally. Given the differences in techniques, types of coils, and size of aneurysms, there are no clear data on the “average number of coils needed for each procedure.” It is clear that the direct cost of consumables for the endovascular coiling of cerebral aneurysms exceeds that of clipping in the majority of procedures.1–3 However, it is questionable whether there is any difference in overall cost of treatment between the 2 modalities.1,2,4 Given the global variations in medical costs on multiple levels ranging from hospitalization costs, materials, physician reimbursement, medical liability, and so on, it would be impossible to generate recommendations based on cost analysis. The “Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Hear Association” sought to provide evidence-based management for the treatment of ruptured cerebral aneurysms.5 We sought to concentrate on the scientific and clinical evidence for treatment and management of aneurysmal subarachnoid hemorrhage. We are cognizant of the fact that ultimate treatment decisions are based on a multitude of variables: scientific and clinical evidence, social, and economic.

In the article “Remodeling of the Corticospinal Innervation and Spontaneous Behaviorial Recovery After Ischemic Stroke in Adult Mice”, by Liu et al,1 there are several errors in Table 2. First, in the title, “States” should read “Status”. Second, the values for row “Day 32”, column “Right PRV Labeling” should read r=0.91 and P<0.01, and for column “Left PRV Labeling” should read r=−0.66 and P=0.08. The values were inadvertently transposed for publication. The authors regret these errors.

The corrected version can be viewed online at

http://stroke.ahajournals.org.

1[Correction for Vol 40, Number 7, July 2009. Pages 2546–2551.]