Clip, coil or wait it out? Doctors debate aneurysms
Reviewed By
Rating
Clip, coil or wait it out? Doctors debate aneurysms
Our Review Summary
This article presented some treatment options available to people who find that they have a bulging blood vessel (aneurysm) in their brain. It highlighted the experience of a single patient who decided with her neurosurgeon that a surgical intervention to reduce the chance that this aneurysm would break open or rupture.
The article did not mention availability or approval for clip and coil. The story says “Only a half-dozen or so neurosurgeons in the U.S. clip more cerebral aneurysms than Nussbaum in any given year.” It also says “but many specialists now prefer coiling.” But that doesn’t tell us how widespread these practices are in real numbers. The story says, “At St. Joseph’s, Nussbaum is outnumbered by the three doctors who perform coiling. Still, Nussbaum said, his caseload grows every year.” Again, this doesn’t help the reader because it provides no absolute numbers, only relative ratios. And no long-term data on benefits or harms are given. Maybe they don’t exist. Readers should be told.
The article did make an attempt to highlight the correlations among the number of imaging procedures done, the number of aneurysms found and the number of invasive procedures done to treat them. Although the articles does state that “Not all aneurysms are treated (with surgery), and that is probably best.” and “lack of clinical trials proving which one [clip or coil] is superior”, the majority of the article emphasizes a self- acknowledged “pretty aggressive” surgeon who is one of the 6 most frequent performers of the procedure in the US. However, by featuring only one patient and her physician, the article did appear to be slanted toward the treatment choice of this pair, perhaps obscuring the point that not all brain aneurysms are in danger of rupturing and therefore not all brain aneurysms, though scary sounding, need to be treated. Why wasn’t a watchful waiting patient profiled? The choice of patient anecdotes lends a biasing weight to the story.
The article could have easily made the point more clearly that because most aneurysms never rupture (only 1% per year do), that the risk of harms associated with the surgery may be greater than those associated with not having a procedure done. The surgical complications from treating an unruptured aneurysm were reported in the article as being 5% (or 1% for one surgeon). The article mentioned a study from 2003 in which it was found that only 55% of coiling procedures completely cut off blood flow to the aneurysms without explaining whether it was essential that all blood flow be cut off and if it affected subsequent chance of aneurysm rupture.
There was no cost information for either invasive procedure; there was also no cost information for the imaging studies that can be used to detect and follow such aneurysms. The article, however, did mention that insurance covers both coils and clips. But how much is someone paying for all of this? That’s an important issue.
Criteria
Not Satisfactory
There was no cost information for either invasive procedure; there was also no cost information for the imaging studies that can be used to detect and follow such aneurysms. The article, however, did mention that insurance covers both coils and clips.
Not Satisfactory
The article mentioned a study currently underway at the Mayo Clinic that has found that the risk of small aneurysms is so small that they don’t warrant the risk of surgery. However, there were no quantitative estimates of benefit of treatment. While there were no specific benefits given for the coil, mentioned as “a less invasive procedure,” the article included the opinion that coiling may, at some point in the future, replace almost all clipping surgeries.
Not Satisfactory
The article was not clear that because most aneurysms never rupture (only 1% per year do), that the risk of harms associated with the surgery may be greater than those associated with not having a procedure done. The surgical complications from treating an unruptured aneurysm were reported in the article as being 5% (or 1% for one surgeon). The article mentioned a study from 2003 in which it was found that only 55% of coiling procedures completely cut off blood flow to the aneurysms without explaining whether it was essential that all blood flow be cut off and if it affected subsequent chance of aneurysm rupture.
Not Satisfactory
Although the headline promises a discussion of “debate”, the article tends to be lopsided with the majority of the article focusing on a particular patient and one surgeon. The reported complication rate of this procedure is 5% or higher, but later in the story the surgeon reports his complication rate as 5 in 450. No source or independent data is provided for the actual complication rate seen. Moreover, this particular surgeon says he has not yet published his results and patient selection could potentially confound his reported results. His statement also suggests that patients may be able to achieve better results if they see him because he does lots of these. These are not evidence-based comments.
Not Satisfactory
The article did make an attempt to highlight the correlations among the number of imaging procedures done, the number of aneurysm found and the number of invasive procedures done to treat them. Although the articles does state that “Not all aneurysms are treated (with surgery), and that is probably best.” and “lack of clinical trials proving which one [clip or coil] is superior”, the majority of the article emphasizes a self- acknowledged “pretty aggressive” surgeon who is one of the 6 most frequent performers of the procedure in the US. However, by featuring only one patient and her physician, the article did appear to be slanted toward the treatment choice of this pair, perhaps obscuring the point that not all brain aneurysms are in danger of rupturing and therefore not all brain aneurysms, though scary sounding, need to be treated. Why wasn’t a watchful waiting patient profiled? The choice of patient anecdotes lends a biasing weight to the story.
Satisfactory
Although most of the story focused on the experience of one surgical group in one institution, there was some input from another expert at another medical center, so we’ll give the story the benefit of the doubt and rate it satisfactory.
Satisfactory
This article mentions brain surgery (old approach), watchful waiting and 2 new approaches (clips and coils).
The article should have been explained why it was not surprising that the physician described as clipping more cerebral aneurysms than almost any other neurosurgeons in the U.S., would advise the patient in the article to have this procedure done
Not Satisfactory
The article did not make clear whether both treatments as well as the watchful waiting approach were readily available . Options include surgery, watchful waiting and coil or clip. The article did not mention availability or approval for clip and coil. The story says “Only a half-dozen or so neurosurgeons in the U.S. clip more cerebral aneurysms than Nussbaum in any given year.” It also says “but many specialists now prefer coiling.” But that doesn’t tell us how widespread these practices are in real numbers.
The story says, “At St. Joseph’s, Nussbaum is outnumbered by the three doctors who perform coiling. Still, Nussbaum said, his caseload grows every year.” Again, this doesn’t help the reader because it provides no absolute numbers, only relative ratios.
Not Satisfactory
There was no mention of FDA approval for these devices or of how long the new procedures (coils and clips) have been in use. If they’ve been used for a while, how much long-term data is there, and how long is the long-term data? These are important questions not answered in the story.
Satisfactory
Although most of the story focused on the experience of one surgical group in one institution, there was some input from another expert at another medical center, so we don’t think the story relied solely on a news release.
Total Score: 3 of 10 Satisfactory
Comments
Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.
Our Comments Policy
But before leaving a comment, please review these notes about our policy.
You are responsible for any comments you leave on this site.
This site is primarily a forum for discussion about the quality (or lack thereof) in journalism or other media messages (advertising, marketing, public relations, medical journals, etc.) It is not intended to be a forum for definitive discussions about medicine or science.
We will delete comments that include personal attacks, unfounded allegations, unverified claims, product pitches, profanity or any from anyone who does not list a full name and a functioning email address. We will also end any thread of repetitive comments. We don”t give medical advice so we won”t respond to questions asking for it.
We don”t have sufficient staffing to contact each commenter who left such a message. If you have a question about why your comment was edited or removed, you can email us at feedback@healthnewsreview.org.
There has been a recent burst of attention to troubles with many comments left on science and science news/communication websites. Read “Online science comments: trolls, trash and treasure.”
The authors of the Retraction Watch comments policy urge commenters:
We”re also concerned about anonymous comments. We ask that all commenters leave their full name and provide an actual email address in case we feel we need to contact them. We may delete any comment left by someone who does not leave their name and a legitimate email address.
And, as noted, product pitches of any sort – pushing treatments, tests, products, procedures, physicians, medical centers, books, websites – are likely to be deleted. We don”t accept advertising on this site and are not going to give it away free.
The ability to leave comments expires after a certain period of time. So you may find that you’re unable to leave a comment on an article that is more than a few months old.