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International Subarachnoid Aneurysm Trial (ISAT) of
neurosurgical clipping versus endovascular coiling in
2,143 patients with ruptured intracranial aneurysms:
a randomised trial.
Molyneux A, Kerr R, Stratton
I, Sandercock P, Clarke M, Shrimpton J, Holman R.
Lancet. 2002: 360: 1267-74.
Purpose: Determine whether endovascular treatment
compared with neurosurgical treatment reduced the proportion
of patients dependent or dead, defined by a modified
Rankin score of 3-6
METHODS:
2143 patients randomly assigned endovascular coil treatment
(n=1070) or neurosurgical clipping (n=1073). Most randomized
patients had good-grade (88 percent in WFNS grades I
and II), small anterior circulation aneurysms (92 percent
less than 11 mm in size).
RESULTS:
| RESULTS: |
Endovascular
(n=801)
|
Surgical
(n=793)
|
| Died or had mRS
score 3-6 at 1 year |
23.7%
|
30.6%
|
- Relative risk reduction favoring coiling is 22.6%.
Absolute risk reduction is 6.9%.*
- The risk of rebleeding during the first year was
2.4 percent for the endovascular group and 1.0 percent
for the surgical group. Rebleeding after 1 year was
2 per 1,276 follow-up years for coiling patients and
0 per 1,081 follow-up years for surgical patients.
CONCLUSION:
In ruptured brain aneurysm patients, equally suited
for both treatment options, endovascular coil treatment
produces substantially better patient outcomes than
surgery in terms of survival free of disability at one
year.
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