Research

This section provides summaries of published clinical papers from peer reviewed journals pertaining to the neurosurgical and endovascular management of intracranial aneurysms.

International Subarachnoid Aneurysm Trial
The International Subarachnoid Aneurysm Trial -- or ISAT -- is the only multi-center, prospective randomized trial comparing the safety and efficacy of endovascular coil treatment with neurosurgical clipping for the treatment of ruptured brain aneurysms. The study found that, in 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.

Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet. 2002: 360: 1267-74.

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Association between Subarachnoid Hemorrhage Outcomes and Number of Cases Treated at California Hospitals
The discharge abstracts for all patients with a primary diagnosis of subarachnoid hemorrhage admitted through the emergency department to nonfederal hospitals in California from 1990 to 1999 were analyzed. The study found that hospitals that treated more cases of subarachnoid hemorrhage had substantially lower rates of in-hospital mortality.

Bardach NS, et al. Association between subarachnoid hemorrhage outcomes and number of cases treated at California hospitals. Stroke. 2002 Jul; 33(7): 1851-6.

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Treatment of Unruptured Cerebral Aneurysms in California
To determine the impact of endovascular coil treatment as compared with neurosurgical clipping on treatment outcomes, all primary diagnoses of unruptured cerebral aneurysms were retrieved from a statewide database of hospital discharges in California. The study found that endovascular treatment of unruptured aneurysms is associated with less risk of adverse outcomes, lower hospital charges and shorter hospital stays compared with surgery.

Johnston SC. Treatment of Unruptured Cerebral Aneurysms in California. Stroke. 2001 Mar; 32(3):597-605.

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Endovascular and Surgical Treatment of Unruptured Cerebral Aneurysms: Comparison of Risks
A blinded retrospective study compared surgical clipping with endovascular treatment of 130 unruptured aneurysms at the University of California San Francisco Hospital. The study found that endovascular treatment is associated with fewer adverse outcomes, lower hospital charges, shorter hospital stays and shorter recovery times than neurosurgical clipping.

Johnston SC, et.al. Endovascular and Surgical Treatment of Unruptured Cerebral Aneurysms: Comparison of Risks. Ann Neurology 2000; 48:11-19

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Surgical and Endovascular Treatment of Unruptured Cerebral Aneurysms at University Hospitals
A three-and-a -half-year study compared adverse outcomes, hospital stay duration, and cost of neurosurgical clipping and endovascular coil therapy in the treatment of unruptured aneurysms at 60 university hospitals. The study found that endovascular treatment of unruptured aneurysms resulted in fewer adverse outcomes, lower hospital charges, shorter hospital stays and shorter recovery times than neurosurgical clipping.

Johnston SC, et. al. Surgical and Endovascular Treatment of Unruptured Cerebral Aneurysms at University Hospitals. Neurology 1999; 52:1799-1805

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BRAT (Barrow Ruptured Aneurysm Trial)
The BRAT study was a randomized trial that compared open surgical clipping to endovascular coiling in a randomized fashion for all ruptured aneurysms.  The study found that after one year 33.7% of patients in the surgical arm of the study had a poor outcome vs 23.2% in the endovascular arm.

Cameron G. McDougall, M.D., Robert F. Spetzler, M.D., Joseph M. Zabramski, M.D., Shahram Partovi, M.D.,,Nancy K. Hills, Ph.D., Peter Nakaji, M.D., and Felipe C. Albuquerque, M.D. The Barrow Ruptured Aneurysm Trial Clinical.  Journal of Neurosurgery Jan 2012; Vol. 116; No. 1; 135-144. published online November 4, 2011; DOI: 10.3171/2011.8.JNS101767

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Patient Outcomes Are Better for Unruptured Cerebral Aneurysms Treated at Centers That Preferentially Treat with Endovascular Coiling: A Study of the National Inpatient Sample 2001–2007
A study found that patient morbidity and mortality were lower when treated at centers that performed a higher percentage of endovascular coiling procedures.

W. Brinjikji, A.A. Rabinstein, G. Lanzino, D.F. Kallmes and H.J. Cloft. American Journal of Neuroradiology 2011 32: 1065-1070. Published online before print April 21, 2011, doi: 10.3174/ajnr.A2446

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In-Hospital Morbidity and Mortality after Endovascular Treatment of Unruptured Intracranial Aneurysms in the United States, 1996–2000: Effect of Hospital and Physician Volume
The purpose of this study was to determine the risk of adverse outcomes after contemporary endovascular treatment of unruptured intracranial aneurysms in the United States.

Brian L. Hoh, James D. Rabinov, Johnny C. Pryor, Bob S. Carter and Fred G. Barker II. American Journal of Neuroradiology 2003 24: 1409-1420

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