After the International Subarachnoid Trial reported favorable outcome in a coiling group in treatment for ruptured cerebral aneurysms, we changed our strategy as follows. We performed cerebral angiography as soon as possible after onset, and treated aneurysms by coiling as our primary choice. In this paper, we report our treatment and results over the past 4 years (2006-2010), and discuss the role and limitation of coiling. In the first half period (January in 2006-March in 2008), we performed clipping in 52 cases and coiling in 23 cases. On the other hand, in the second half period (March in 2008-March in 2010), more than half of aneurysms were embolized (44 coiling and 38 clipping). Many anterior (Acom) and posterior communicating artery aneurysms were treated by coiling in the second half, while those in the first half were treated by clipping. Coiling was difficult in a few Acom aneurysms, because of their shape and access route up to the aneurysms. Most middle cerebral aneurysms were cured by clipping in both periods. Hospitalization was shortened in the second half, although modified Rankin scale at discharge was the same in both periods.
Coiling seemed to be effective in treatment for half of ruptured aneurysms. However, care must be taken in considering coiling for Acom aneurysms.